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Signa Vitae

Journal of Intensive Care and Emergency Medicine

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Methemoglobinemia caused by accidental poisoning by nitric oxide – case report

Abstract

The aim of this paper is to present a case of methemoglobinemia induced by accidental poisoning by nitric oxide, in a male infant at the age of 3 months and 4 days. Methemoglobinemia is a disease in which the hemoglobin is in the oxidized form and can not bind oxygen, and becomes manifested when erythrocytes contain more than 1% of methemoglobin. This condition can be idiopatic or acquired, and requires sub-specialist diagnostic evaluation and treatment.

Key words: methemoglobinemia, nitric oxide, infant

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Poincaré plot indices as a marker for acute pain response in newborns

Abstract

Traditional views on neonatal pain neglected long neglected the neonates’ capability of feeling pain. Newborn infants experience at least one painful procedure during their first days of life, but with a lower gestational age, invasive procedures become more frequent and invasive. The modulation of the autonomic nervous system (ANS) is significantly changed during painful procedures. The analysis of the heart rate variability is shown to be a reliable tool in analyzing the ANS. In this study, the dynamic of the system has been examined by applying the Poincaré plot analysis, a primer of nonlinear methods used in the analysis of the ANS. The aim of this study is to assess the occurrence of changes in linear heart rate variability parameters, to determine the changes in the Poincaré plot indices and to evaluate the correlation between their differences in healthy newborns. The results have shown a significant increase in the heart rate, a reduction of the duration of RR intervals, and the square root of the mean squared differences between successive RR intervals (RMSSD), as well as a decrease in the short-term variability (SD1) of the Poincare plot. The results highlight the need for studying the application of nonlinear analyses of the HRV on the effects of pain on the ANS and its long-term effects on the infant.

Key words: autonomic nervous system, pain, poincare plot, nonlinear analysis, heart rate variability

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Influence of different factors to prolonged adaptation of the neonate

Abstract

The neonate must make a transition after birth from intrauterine continuous transplacental supply of oxygen and glucose to different extra uterine conditions. In healthy neonate the period of adaptation almost finished in the perinatal period and newborn can be safely discharged after this time. Retrospective study in the NICU, Clinical Hospital Osijek, during the year 2016 was done. Almost 26% of neonates were admitted in NICU because of the prolonged adaptation to extra uterine life. It was their main diagnosis. The majority of them have been polycytemic, had early jaundice and a part of them had bradycardia. Mother’s illnesses as a possible cause of prolonged neonatal adaptation were found in 21.7%. About 58.3% of newborns with prolonged adaptation have had problems during mother’s pregnancy and delivery. Hypertrophic as well as hypotrophic neonates were risk neonates for prolonged postnatal adaptation, as well as newborns gender. Mode of delivery takes a big role in the neonatal adaptation. Induction and augmentation of the labor acts as a possibly stress factor. Main symptoms among those newborns were: plethora, cyanotic crises, bradicardia, dystonia, irritability, jaundice and respiratory distress. Most of the investigated newborns need oxygen 6-10 days. The majority of them stay in the hospital up to 10 days. Prolonged adaptation has almost equally been found in the first, second and third pregnancy.

Key words: neonatal adaptation, perinatal stress, pregnancy complications, delivery mode, induction and augmentation of labor, polycythemia, bradicardia

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A case report of pulmonary vascular air embolism in elbw premature neonate

Introduction

Pulmonary vascular air embolism is a rare and almost fatal complication of positive pressure ventilation  in premature neonates with respiratory distress syndrome

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 The human microbiome in health and disease

Humans consist only of our own somatic cells until birth, but over the first several years of life, our bodies, including the skin surface, mammary glands, placenta, seminal fluid, uterus, ovarian follicles, lung, saliva, oral mucosa, conjuctiva and gastrointestinal tracts are colonized by an enormous variety of bacteria, archaea, protists, fungi and viruses, which form a community collectively known as the human microbiota. The human microbiome refers specifically to the collective genomes of resident microorganisms.

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