Background. The use of ALP in neonatology has been intensively studied, and associations have bee... more Background. The use of ALP in neonatology has been intensively studied, and associations have been demonstrated between elevated alkaline phosphatase levels and hypocalcemia and hypophosphatemia in premature infants, the onset of early osteopenia and the occurrence of necrotizing enterocolitis. Objective. The current study aimed to verify if there is any kind of statistical correlation between elevated alkaline phosphatase levels in blood from the umbilical cord and the presence of signs of hemolysis. Material and methods. The study included 250 term newborns that met all the inclusion criteria. Alkaline phosphatase was determined in the umbilical cord serum together with hemoglobin and hematocrit. Results. There was no statistically significant difference between the median hematocrit and hemoglobin values correlated with elevated alkaline phosphatase values for the two groups – with and without phototherapy. Conclusion. In order to build on the correlations of alkaline phosphatase...
Congenital cystic adenomatoid malformation (CCAM) is a rare fetal malformation of the lower respi... more Congenital cystic adenomatoid malformation (CCAM) is a rare fetal malformation of the lower respiratory tract. After the development and frequent use of the obstetric ultrasound, those lesions can be detected antenatally, which leads to a proper intrauterine and neonatal management. In this article, we present the case of a term newborn who was diagnosed with congenital cystic adenomatoid of the lower left lung lobe. In evolution, the lung cysts increased in size, occupying almost entirely the left lung. However, the clinical evolution of the newborn was favorable, which made possible the delay of the surgical intervention for an older age.
Inflammatory bowel diseases (IBD) – ulcerative colitis, Chron disease and indeterminate colitis –... more Inflammatory bowel diseases (IBD) – ulcerative colitis, Chron disease and indeterminate colitis – affect mainly women at childbearing age, resulting in a challenge for obtaining a pregnancy. The aim of the therapeutic management is to obtain a good control of the disease before conception, with a combined medical surveillance throughout pregnancy (gastroenterological, obstetrical and neonatal). The advances in IBD treatment during pregnancy and lactation have resulted in a better maternal-fetal outcome. Weak control of the disease correlates with specific complications, such as misscariage, premature birth, insufficient intrauterine growth, preeclampsia, increased number of caesarean sections, low Apgar score at birth. The association between inflammatory intestinal disease, its treatment and the occurrence of fetal malformations remains controversial, although numerous studies have been conducted to verify this aspect. The introduction of biological therapy in the treatment of infl...
Current data regarding the effect of cigarette smoking on fetal weight shows that, depending on t... more Current data regarding the effect of cigarette smoking on fetal weight shows that, depending on the number of cigarettes consumed per day and the time of exposure, the fetal weight deficit at birth is between 100 and 300 grams (Rodriguez-Thompson, 2017). Continuous maternal smoking during pregnancy of less than 10 cigarettes per day results in a fall in fetal weight at birth of approximately 220 g, while the continuous smoking of more than 10 cigarettes per day leads to a decrease in fetal weight at birth of approximately 300 g. Our study assessed the influence of cigarette smoking during pregnancy on fetal weight in the second and third trimesters.
The global health crisis created by the COVID-19 pandemic requires effective prevention strategie... more The global health crisis created by the COVID-19 pandemic requires effective prevention strategies and therapeutic approaches at a worldwide scale. Regarding pregnant women, the observational studies have shown that pregnant patients have an increased risk of severe illness with intensive care unit (ICU) admissions, need for mechanical ventilation, death or adverse pregnancy course, with high risk of preterm birth and postpartum complications. It is challenging to counsel the pregnant patients about the efficacy and safety of the approved COVID-19 vaccines due to the lack of data from clinical trials. All worldwide international and national government agencies and professional associations take different position regarding the vaccination against COVID-19 in pregnant women, in those aiming to be pregnant and in breastfeeding patients. The solution to this public health issue is based on the development of COVID-19 vaccines in current and planned clinical trials. This paper aims to ...
<jats:p>Inflammatory bowel diseases (IBD) – ulcerative colitis, Chron disease and indetermi... more <jats:p>Inflammatory bowel diseases (IBD) – ulcerative colitis, Chron disease and indeterminate colitis – affect mainly women at childbearing age, resulting in a challenge for obtaining a pregnancy. The aim of the therapeutic management is to obtain a good control of the disease before conception, with a combined medical surveillance throughout pregnancy (gastroenterological, obstetrical and neonatal). The advances in IBD treatment during pregnancy and lactation have resulted in a better maternal-fetal outcome. Weak control of the disease correlates with specific complications, such as misscariage, premature birth, insufficient intrauterine growth, preeclampsia, increased number of caesarean sections, low Apgar score at birth. The association between inflammatory intestinal disease, its treatment and the occurrence of fetal malformations remains controversial, although numerous studies have been conducted to verify this aspect. The introduction of biological therapy in the treatment of inflammatory bowel disease in pregnancy led to a better control of the disease, but brought new challenges for obstetricians and neonatologists. </jats:p>
Aim: To present the systematic ultrasonographic assessment in fetal osteochondrodysplasias and to... more Aim: To present the systematic ultrasonographic assessment in fetal osteochondrodysplasias and to evaluate the fetal MRI intake, as a complementary exploration to US, in the prenatal diagnosis and perinatal prognosis of fetal nonlethal osteochondrodysplasias. Material and methods: In this tertiary multicentre study were included 37 cases diagnosed prenatally with various entities in the category of nonlethal fetal osteochondrodysplasias. The initial diagnosis was carried out by the routine or detailed ultrasound examination. Fetal MRI was accomplished for selected cases. Results: Nonlethal skeletal dysplasia was suspected and then diagnosed after 17 gestational weeks. The suspicion of osteochondrodysplasia as a reference diagnosis element has required systematic and thorough ultrasound examination. Fetal MRI is a valuable exploration, complementary to prenatal ultrasound bringing in very useful details for the diagnosis of osteochondrodysplasias. The global diagnosis of skeletal dys...
To investigate if early pregnancy serum neopterin concentrations (EPSN) could predict spontaneous... more To investigate if early pregnancy serum neopterin concentrations (EPSN) could predict spontaneous preterm birth (SPB). EPSN was measured in 92 sera collected from 46 pregnant women with birth at term and 40 sera from 20 pregnant women with preterm birth. Two sera were collected for each case: in the first and early second trimester. EPSN concentrations correlate with gestational age (ρ=0.275, P=0.001), a correlation which was present in both groups: term and preterm birth. EPSN were higher in pregnancies with SPB compared with normal pregnancies (6.27±1.03 vs. 6.04±0.15, P=0.039). Patients with SPB showed a considerable increase of EPSN in the second trimester compared with patients with birth at term (7.30±1.53 vs. 6.16±0.23, P=0.043). A sharper increase was found in the group with SPB before 32 weeks of pregnancy (wp) (9.83±4.36 vs. 6.16±0.23, P=0.016). Pregnant women with an early second trimester serum neopterin value of above 8 nmol/L are associated with a risk of SPB before 32...
Donald School Journal of Ultrasound in Obstetrics and Gynecology, 2012
Objectives Assessment of the fetal behavior in normal and high-risk pregnancy during second and t... more Objectives Assessment of the fetal behavior in normal and high-risk pregnancy during second and third trimesters. Materials and methods The study group included 61 healthy pregnant women and 135 pregnant women with high-risk pregnancy between 24 and 38 weeks of gestation for a period of 3 years (January 2009-May 2011). After 4D ultrasound examination we applied antenatal neurological score KANET 1. Score is considered normal between 14 and 20, borderline between 6 and 13 and abnormal between 0 and 5. Results The Kurjak antenatal neurological test (KANET) scores have significant differences, when applied on the two groups of pregnant women. Most fetuses who obtained normal KANET score were found in normal pregnancies, those who obtained borderline score were fetuses with intrauterine growth restriction (IUGR) with increased resistance index (RI) of middle cerebral artery (ACM) and the most fetuses with abnormal KANET score came from pregnancies complicated by threatened preterm deliv...
Donald School Journal of Ultrasound in Obstetrics and Gynecology, 2015
ABSTRACTBackgroundWhile two-dimensional ultrasound (2D US) is used only for the assessment of fet... more ABSTRACTBackgroundWhile two-dimensional ultrasound (2D US) is used only for the assessment of fetal startles and general movements, introduction of Kurjak antenatal neurodevelopmental test (KANET) by four-dimensional ultrasound (4D US) enabled assessment of not only movements but also some signs used in postnatal neurological assessment like cranial sutures, head circumference and finger movements of the hand for the detection of neurological thumb (adducted thumb in the clenched feast). Overall impression on general movement called by Prechtl ‘Gestalt perception’ is also a part of KANET assessment. These parameters cannot be assessed by 2D US, and according to our opinion they are making the difference enabling more accurate and functionally more reliable assessment of the young and immature CNS.After Osaka standardization of KANET has been published, many studies on fetal behavior from different centers using this method have been conducted and published. Although there is lack of...
Donald School Journal of Ultrasound in Obstetrics and Gynecology, 2015
Technical and therapeutic advances have driven the development of fetal MRI, which is likely to b... more Technical and therapeutic advances have driven the development of fetal MRI, which is likely to become an increasingly important modality in the evaluation of sonographically complex or occult anomalies of the fetal brain and body. All radiologists involved in prenatal imaging should be aware of the applications and limitations of this modality. Magnetic resonance imaging (MRI) studies have consistently demonstrated brain structural changes on intrauterine growth restriction (IUGR). There is a need to improve MRI characterization of the anatomical patterns of brain reorganization associated with IUGR and to develop specific imaging biomarkers. Contrary to acute perinatal events, IUGR is a chronic condition that induces brain reorganization and abnormal maturation rather than gross tissue destruction. Diffusion MRI offers a promising approach to assess abnormalities in brain maturation and develop biomarkers for clinical use. The association between IUGR and short- and long-term neur...
Donald School Journal of Ultrasound in Obstetrics and Gynecology, 2013
Advances in perinatal and neonatal medicine have significantly improved survival rates of preterm... more Advances in perinatal and neonatal medicine have significantly improved survival rates of preterm infants. This improvement has been associated with substantial risk of neurodevelopmental impairments and with increased number of infants with special health care needs. Cerebral palsy is the most well known and potentially most disabling motor abnormality associated with prematurity. There has been limited progress in understanding the causes of cerebral palsy and in developing primary prevention strategies. Several studies have summarized the experimental evidence that supports possible neuroprotective effects of magnesium. Five randomized controlled trials of antenatal magnesium sulfate found a trend of reduced risk of cerebral palsy in preterm infants. Three meta-analyses using the data from these five trials found that magnesium sulfate given to women at risk of premature birth significantly reduced the risk of cerebral palsy without increasing the risk of perinatal or infant deat...
Background. The use of ALP in neonatology has been intensively studied, and associations have bee... more Background. The use of ALP in neonatology has been intensively studied, and associations have been demonstrated between elevated alkaline phosphatase levels and hypocalcemia and hypophosphatemia in premature infants, the onset of early osteopenia and the occurrence of necrotizing enterocolitis. Objective. The current study aimed to verify if there is any kind of statistical correlation between elevated alkaline phosphatase levels in blood from the umbilical cord and the presence of signs of hemolysis. Material and methods. The study included 250 term newborns that met all the inclusion criteria. Alkaline phosphatase was determined in the umbilical cord serum together with hemoglobin and hematocrit. Results. There was no statistically significant difference between the median hematocrit and hemoglobin values correlated with elevated alkaline phosphatase values for the two groups – with and without phototherapy. Conclusion. In order to build on the correlations of alkaline phosphatase...
Congenital cystic adenomatoid malformation (CCAM) is a rare fetal malformation of the lower respi... more Congenital cystic adenomatoid malformation (CCAM) is a rare fetal malformation of the lower respiratory tract. After the development and frequent use of the obstetric ultrasound, those lesions can be detected antenatally, which leads to a proper intrauterine and neonatal management. In this article, we present the case of a term newborn who was diagnosed with congenital cystic adenomatoid of the lower left lung lobe. In evolution, the lung cysts increased in size, occupying almost entirely the left lung. However, the clinical evolution of the newborn was favorable, which made possible the delay of the surgical intervention for an older age.
Inflammatory bowel diseases (IBD) – ulcerative colitis, Chron disease and indeterminate colitis –... more Inflammatory bowel diseases (IBD) – ulcerative colitis, Chron disease and indeterminate colitis – affect mainly women at childbearing age, resulting in a challenge for obtaining a pregnancy. The aim of the therapeutic management is to obtain a good control of the disease before conception, with a combined medical surveillance throughout pregnancy (gastroenterological, obstetrical and neonatal). The advances in IBD treatment during pregnancy and lactation have resulted in a better maternal-fetal outcome. Weak control of the disease correlates with specific complications, such as misscariage, premature birth, insufficient intrauterine growth, preeclampsia, increased number of caesarean sections, low Apgar score at birth. The association between inflammatory intestinal disease, its treatment and the occurrence of fetal malformations remains controversial, although numerous studies have been conducted to verify this aspect. The introduction of biological therapy in the treatment of infl...
Current data regarding the effect of cigarette smoking on fetal weight shows that, depending on t... more Current data regarding the effect of cigarette smoking on fetal weight shows that, depending on the number of cigarettes consumed per day and the time of exposure, the fetal weight deficit at birth is between 100 and 300 grams (Rodriguez-Thompson, 2017). Continuous maternal smoking during pregnancy of less than 10 cigarettes per day results in a fall in fetal weight at birth of approximately 220 g, while the continuous smoking of more than 10 cigarettes per day leads to a decrease in fetal weight at birth of approximately 300 g. Our study assessed the influence of cigarette smoking during pregnancy on fetal weight in the second and third trimesters.
The global health crisis created by the COVID-19 pandemic requires effective prevention strategie... more The global health crisis created by the COVID-19 pandemic requires effective prevention strategies and therapeutic approaches at a worldwide scale. Regarding pregnant women, the observational studies have shown that pregnant patients have an increased risk of severe illness with intensive care unit (ICU) admissions, need for mechanical ventilation, death or adverse pregnancy course, with high risk of preterm birth and postpartum complications. It is challenging to counsel the pregnant patients about the efficacy and safety of the approved COVID-19 vaccines due to the lack of data from clinical trials. All worldwide international and national government agencies and professional associations take different position regarding the vaccination against COVID-19 in pregnant women, in those aiming to be pregnant and in breastfeeding patients. The solution to this public health issue is based on the development of COVID-19 vaccines in current and planned clinical trials. This paper aims to ...
<jats:p>Inflammatory bowel diseases (IBD) – ulcerative colitis, Chron disease and indetermi... more <jats:p>Inflammatory bowel diseases (IBD) – ulcerative colitis, Chron disease and indeterminate colitis – affect mainly women at childbearing age, resulting in a challenge for obtaining a pregnancy. The aim of the therapeutic management is to obtain a good control of the disease before conception, with a combined medical surveillance throughout pregnancy (gastroenterological, obstetrical and neonatal). The advances in IBD treatment during pregnancy and lactation have resulted in a better maternal-fetal outcome. Weak control of the disease correlates with specific complications, such as misscariage, premature birth, insufficient intrauterine growth, preeclampsia, increased number of caesarean sections, low Apgar score at birth. The association between inflammatory intestinal disease, its treatment and the occurrence of fetal malformations remains controversial, although numerous studies have been conducted to verify this aspect. The introduction of biological therapy in the treatment of inflammatory bowel disease in pregnancy led to a better control of the disease, but brought new challenges for obstetricians and neonatologists. </jats:p>
Aim: To present the systematic ultrasonographic assessment in fetal osteochondrodysplasias and to... more Aim: To present the systematic ultrasonographic assessment in fetal osteochondrodysplasias and to evaluate the fetal MRI intake, as a complementary exploration to US, in the prenatal diagnosis and perinatal prognosis of fetal nonlethal osteochondrodysplasias. Material and methods: In this tertiary multicentre study were included 37 cases diagnosed prenatally with various entities in the category of nonlethal fetal osteochondrodysplasias. The initial diagnosis was carried out by the routine or detailed ultrasound examination. Fetal MRI was accomplished for selected cases. Results: Nonlethal skeletal dysplasia was suspected and then diagnosed after 17 gestational weeks. The suspicion of osteochondrodysplasia as a reference diagnosis element has required systematic and thorough ultrasound examination. Fetal MRI is a valuable exploration, complementary to prenatal ultrasound bringing in very useful details for the diagnosis of osteochondrodysplasias. The global diagnosis of skeletal dys...
To investigate if early pregnancy serum neopterin concentrations (EPSN) could predict spontaneous... more To investigate if early pregnancy serum neopterin concentrations (EPSN) could predict spontaneous preterm birth (SPB). EPSN was measured in 92 sera collected from 46 pregnant women with birth at term and 40 sera from 20 pregnant women with preterm birth. Two sera were collected for each case: in the first and early second trimester. EPSN concentrations correlate with gestational age (ρ=0.275, P=0.001), a correlation which was present in both groups: term and preterm birth. EPSN were higher in pregnancies with SPB compared with normal pregnancies (6.27±1.03 vs. 6.04±0.15, P=0.039). Patients with SPB showed a considerable increase of EPSN in the second trimester compared with patients with birth at term (7.30±1.53 vs. 6.16±0.23, P=0.043). A sharper increase was found in the group with SPB before 32 weeks of pregnancy (wp) (9.83±4.36 vs. 6.16±0.23, P=0.016). Pregnant women with an early second trimester serum neopterin value of above 8 nmol/L are associated with a risk of SPB before 32...
Donald School Journal of Ultrasound in Obstetrics and Gynecology, 2012
Objectives Assessment of the fetal behavior in normal and high-risk pregnancy during second and t... more Objectives Assessment of the fetal behavior in normal and high-risk pregnancy during second and third trimesters. Materials and methods The study group included 61 healthy pregnant women and 135 pregnant women with high-risk pregnancy between 24 and 38 weeks of gestation for a period of 3 years (January 2009-May 2011). After 4D ultrasound examination we applied antenatal neurological score KANET 1. Score is considered normal between 14 and 20, borderline between 6 and 13 and abnormal between 0 and 5. Results The Kurjak antenatal neurological test (KANET) scores have significant differences, when applied on the two groups of pregnant women. Most fetuses who obtained normal KANET score were found in normal pregnancies, those who obtained borderline score were fetuses with intrauterine growth restriction (IUGR) with increased resistance index (RI) of middle cerebral artery (ACM) and the most fetuses with abnormal KANET score came from pregnancies complicated by threatened preterm deliv...
Donald School Journal of Ultrasound in Obstetrics and Gynecology, 2015
ABSTRACTBackgroundWhile two-dimensional ultrasound (2D US) is used only for the assessment of fet... more ABSTRACTBackgroundWhile two-dimensional ultrasound (2D US) is used only for the assessment of fetal startles and general movements, introduction of Kurjak antenatal neurodevelopmental test (KANET) by four-dimensional ultrasound (4D US) enabled assessment of not only movements but also some signs used in postnatal neurological assessment like cranial sutures, head circumference and finger movements of the hand for the detection of neurological thumb (adducted thumb in the clenched feast). Overall impression on general movement called by Prechtl ‘Gestalt perception’ is also a part of KANET assessment. These parameters cannot be assessed by 2D US, and according to our opinion they are making the difference enabling more accurate and functionally more reliable assessment of the young and immature CNS.After Osaka standardization of KANET has been published, many studies on fetal behavior from different centers using this method have been conducted and published. Although there is lack of...
Donald School Journal of Ultrasound in Obstetrics and Gynecology, 2015
Technical and therapeutic advances have driven the development of fetal MRI, which is likely to b... more Technical and therapeutic advances have driven the development of fetal MRI, which is likely to become an increasingly important modality in the evaluation of sonographically complex or occult anomalies of the fetal brain and body. All radiologists involved in prenatal imaging should be aware of the applications and limitations of this modality. Magnetic resonance imaging (MRI) studies have consistently demonstrated brain structural changes on intrauterine growth restriction (IUGR). There is a need to improve MRI characterization of the anatomical patterns of brain reorganization associated with IUGR and to develop specific imaging biomarkers. Contrary to acute perinatal events, IUGR is a chronic condition that induces brain reorganization and abnormal maturation rather than gross tissue destruction. Diffusion MRI offers a promising approach to assess abnormalities in brain maturation and develop biomarkers for clinical use. The association between IUGR and short- and long-term neur...
Donald School Journal of Ultrasound in Obstetrics and Gynecology, 2013
Advances in perinatal and neonatal medicine have significantly improved survival rates of preterm... more Advances in perinatal and neonatal medicine have significantly improved survival rates of preterm infants. This improvement has been associated with substantial risk of neurodevelopmental impairments and with increased number of infants with special health care needs. Cerebral palsy is the most well known and potentially most disabling motor abnormality associated with prematurity. There has been limited progress in understanding the causes of cerebral palsy and in developing primary prevention strategies. Several studies have summarized the experimental evidence that supports possible neuroprotective effects of magnesium. Five randomized controlled trials of antenatal magnesium sulfate found a trend of reduced risk of cerebral palsy in preterm infants. Three meta-analyses using the data from these five trials found that magnesium sulfate given to women at risk of premature birth significantly reduced the risk of cerebral palsy without increasing the risk of perinatal or infant deat...
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