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Monitoring of brain activity in critical sick newborns
Zemánková, Jana ; Kokštein, Zdeněk (advisor) ; Kantor, Lumír (referee) ; Dort, Jiří (referee)
Monitoring of brain activity in critical sick newbornss The aim of the study was evaluation of brain aktivity in neonates with perinatal asphyxia and correlation with short-term and long-term outcome. The second part of this work is focused on maturation of brain activity in preterm newborns. We assessed traces in 88 neonates suffered from perinatal asphyxia (pH 6,96, BE -16,9) in the first part. aEEG traces were evaluated according classification by Hellström-Westas, short-term outcome was evaluated as development of hypoxic-ischemic encephalopathy (classification Sarnat-Sarnat). We divided children into 4 groups for assessment of long-term outcome - normal outcome, mild psychomotoric delay, severe psychomotoric retardation, death in perinatal period. We evaluated relation between aEEG, short-term and long- term outcome and biochemical markers of hypoxia (pH, BE, lactate) and Apgar score. We reached SE 77 %, SP 100 %, PPV 100 %, NPV 74 % in assessment of correlation between aEEG and short-term outcome, SE 92 %, SP 81 %, PPV 74 % a NPV 94 % in relation between aEEG and long-term outcome and SE 100 %, SP 66 %., PPV 64 %., NPV 100 % in correlation between HIE and long-term outcome. There was gained statistically significant dependence between aEEG and umbilical pH, between lactate and aEEG, short-term...
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Quantification of macronutrients in human milk after premature birth depending on the gestational and postnatal age of infant
Burianová, Iva ; Bronský, Jiří (advisor) ; Kokštein, Zdeněk (referee) ; Dvořáková, Hana Marie (referee)
(jednostránkový souhrn) v angličtině Growth restriction of premature newborns is a serious complication for the further development of the infant. It is not yet definitely clear to which extent it is associated with the low content of certain macronutrients of human milk. Maternal characteristics may be connected with human milk macronutrients, but no definite conclusions have been made to date. This study aimed to evaluate the content of macronutrients in human milk samples after preterm delivery during the first 9 weeks of lactation and determine the relationship of maternal-associated factors on the content of macronutrients in human milk after preterm delivery. Milk samples were collected from mothers after premature birth between 24+0-35+6 weeks. Macronutrients and energy content were analyzed by mid-infrared transmission spectroscopy. A total 1917 human milk samples from were analyzed. Median of protein content decreased from 1.6 g/dL in group A and 1.5 g/dL in group B in the first week of life, to 1.1 g/dL in both groups at the end of week 3, and then remained stable up to week 9. Content of carbohydrates and fat was stable during the whole observation, with interindividual differences. Similarly to colostrum, higher protein content and lower carbohydrates content were observed in...
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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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Monitoring of brain activity in critical sick newborns
Zemánková, Jana ; Kokštein, Zdeněk (advisor) ; Kantor, Lumír (referee) ; Dort, Jiří (referee)
Monitoring of brain activity in critical sick newbornss The aim of the study was evaluation of brain aktivity in neonates with perinatal asphyxia and correlation with short-term and long-term outcome. The second part of this work is focused on maturation of brain activity in preterm newborns. We assessed traces in 88 neonates suffered from perinatal asphyxia (pH 6,96, BE -16,9) in the first part. aEEG traces were evaluated according classification by Hellström-Westas, short-term outcome was evaluated as development of hypoxic-ischemic encephalopathy (classification Sarnat-Sarnat). We divided children into 4 groups for assessment of long-term outcome - normal outcome, mild psychomotoric delay, severe psychomotoric retardation, death in perinatal period. We evaluated relation between aEEG, short-term and long- term outcome and biochemical markers of hypoxia (pH, BE, lactate) and Apgar score. We reached SE 77 %, SP 100 %, PPV 100 %, NPV 74 % in assessment of correlation between aEEG and short-term outcome, SE 92 %, SP 81 %, PPV 74 % a NPV 94 % in relation between aEEG and long-term outcome and SE 100 %, SP 66 %., PPV 64 %., NPV 100 % in correlation between HIE and long-term outcome. There was gained statistically significant dependence between aEEG and umbilical pH, between lactate and aEEG, short-term...
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Clinical Application of Lung Function Testing in Children
Bašek, Pavel ; Kokštein, Zdeněk (advisor) ; Kopřiva, František (referee) ; Pohunek, Petr (referee)
SUMMARY: In my thesis I have been able to show important results from the clinical application of lung function testing in young children. Following children with congenital diaphragmatic hernia, we have shown that many survivors of CDH have significant respiratory problems. However, the continual growth of airways and lung corrects the initial pulmonary function deficit. In our study, we reported on exhaled nitric oxide in CDH survivors and found normal, non-elevated levels. Studying children with inflammatory bowel disease, unlike as a single published study in adults, we found elevated exhaled nitric oxide also in children with non-active inflammatory bowel disease. The fact that conventional analysis of spirometric parameters failed in predicting the course of asthma has motivated our group to next study. It was an intriguing observation, that the subjective analysis of clinical severity of obstructive lung disease can be correlated to the measurement of curvature by using a mathematical equation. Nitric oxide is an important mediator of inflammation in several pathological conditions and the tendency to measure exhaled nitric oxide under different conditions has reached the neonatal medicine also. The multiple- breath method allows sampling of exhaled air via side stream during tidal breathing in...
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