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Low Cardiac Output in Extremely Low Gestation Age Neonates and Intraventricular Haemorrhage
Miletín, Jan ; Straňák, Zbyněk (advisor) ; Bayer, Milan (referee) ; Zoban, Petr (referee)
This thesis is a commented monothematic collection of nine publications addressing cardiovascular assessment in preterm and term infants with a special focus on the immediate postnatal period. At the beginning, it provides a literature review of different modalities of Cardiac Output (CO) measurements in neonates, pathophysiology of Peri-intraventricular Haemorrhage (PIVH) in preterm infants and short review of the neonatal transition with some notes on role of the Patent Ductus Arteriosus (PDA). The main thesis is then divided into three logical parts. In the first and the main part, CO measurement possibilities in the neonatal period are reviewed and published with bioreactance identified as a novel emerging method of continuous CO assessment. The second study of this part is a prospective, observational cohort study in infants with a birth weight of less than 1250g. The CO was measured by bioreactance between 6 and 48 hours of age. Infants with PIVH and/or Necrotising Enterocolitis (NEC) had significantly lower CO compared to infants without these complications on day one of life. This low CO was then followed by a significant increase on day two of life. The third study is a prospective observational cohort study in near term and term infants undergoing Therapeutic Hypothermia (TH) for...
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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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Regulatory mechanisms of fetoplacental vasculature in hypoxia
Kafka, Petr ; Cvachovec, Karel (advisor) ; Zoban, Petr (referee) ; Bláha, Jan (referee)
The placenta and the lungs are the only organs that perform a function of blood oxygenation and have a common characteristic - vasoconstriction in response to acute hypoxia. Thus the reaction is in an opposite manner than smooth muscle of systemic arteries does. In this study we focused on the mechanisms that regulate fetoplacental blood vessels in conditions associated with hypoxia. An experimental model of isolated dually perfused rat placenta was used. Our findings demonstrate an essential role of Rho kinase signaling pathway in the mechanism of this hypoxic fetoplacental vasoconstriction (HFPV). Chronic exposure to hypoxia causes a sustain elevation of vascular resistance on fetoplacental blood vessels. It was demonstrated in experiment with low-viscosity salt solution perfusion. Our current results show a significant increase of the fetoplacental vascular resistance with blood perfusion which better reflects in vivo conditions. An increase in fetoplacental vascular resistance may lead to placental hypoperfusion and consequent fetal undernutrition, which is considered one of the key causes of serious fetal and neonatal problems, especially intrauterine growth restriction. Diabetes mellitus is a well-known factor affecting fetal growth. Both chronic hypoxia and diabetes act on vessels partly...
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The mechanism of The Influence of Hypoxia on The Fetoplacental Vascular Bed
Jakoubek, Vít ; Hampl, Václav (advisor) ; Zoban, Petr (referee) ; Vízek, Martin (referee) ; Straňák, Zbyněk (referee)
Placental hypoxia is commonly considered to play an important role in the development of several perinatal and neonatal diseases such as intrauterine growth retardation (IUGR) or preeclampsia. In this disertation we therefore tried to (at least partially) solve this problem by answering the question how do acute and chronic hypoxia affect fetoplacentar vasculature. Unlike all vascular beds with the exception of the pulmonary circulation, fetoplacental vessels respond to acute hypoxia with vasoconstriction ( HFPV). This mechanism presumably diverts blood flow from poorly oxygenated areas towards regions with better O2 supply. We already know, that hypoxia inhibits potassium channels and thus causes depolarization in fetoplacental vascular smooth muscle. We propose that this hypoxia-induced depolarization leads to vasoconstriction by activating voltage- dependent calcium (Ca) channels and Ca influx. We performed our first experiment on the preparation of dually perfused cotyledon of the human placenta, which we gained immediately after uncomplicated spontaneus deliveries or elective caesarian sections. The preparation was perfused with Krebs' saline with dextran and meclophenamate and gased with 40% O2, 5% CO2 a 55% N2. We compared HFPV, which was elicited by changing gasing of the perfusate to the...
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The perception of a premature baby by his mother
Humlová, Gabriela ; Voleníková, Ivana (advisor) ; Zoban, Petr (referee)
The topic of mother's perception of her prematurely bom baby is very interesting to me. I am working in an lntensive Care Dnit for newborns where I regularly meet mothers of prematurely bom infants. Their feelings are different w m the ones experienced by mothers of physiological infants. ln tbis study I wanted to point out how seemingly irrational feelings, as well as reactions wbich can seem inadequate, are actually natura! feelings and reactions to such situations. lt has been pleasant to talk with the mothers about their feelings even though their experiences with prematurely bom babies were traumatizing. Several of the moms have gone through this experience a few years ago; however, even they say that it is irnpossible to forget about that time nor about the feelings they were experiencing throughout the time. Powered by TCPDF (www.tcpdf.org)
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