Aim: The aim of this study was to analyze risk factors and outcome of neonatal pneumothorax in Tuzla Canton. Methods: Neonates with chest X-ray confirmed pneumothorax in University Clinical Center of Tuzla, within a three-year period, from January 2015 to December 2017, were retrospectively studied. Participants were evaluated for baseline characteristics, predisposing factors of neonatal pneumothorax, accompanying disorders and mortality. Results: During the observed three-year period 11425 neonates were born in Tuzla Canton, with 7.33 % of preterm births, and 604 neonates were treated in NICU, with 265 neonates who required mechanical ventilation. Neonatal pneumothorax (NP) was diagnosed in 22 patients (9 term, 13 preterm), 12 (54.5%) were male. The incidence was 0.20% of total births, respectively 3.64% of those treated in NICU. The mean gestational age were 35.1 ± 3.0 weeks and birth weight 2 506.8 ± 727.7 grams. NP was mostly unilateral (72.7%) and right-sided. The most commonly associated diseases were: respiratory distress syndrome, intracranial haemorrhage, pneumonia, transient tachypnea and sepsis. In 8 (36.4%) neonates, the underlying cause of NP could be mechanical ventilation (secondary), whereas in 14 (63.6%) NP was spontaneous, without previous mechanical ventilation, although 11 of them required mechanical ventilation after pneumothorax. Conclusion: All perinatal risk factors were investigate, and significant differences in two observed groups related to mechanical ventilation were found for birth weight, gestational age, Caesarean section, length of mechanical ventilation, surfactant replacement therapy and outcome. Three (13.64%) neonates with NP died, and among risk factors with poor outcome, significant was only Apgar score in the first minute ≤ 5.

Introduction: Acute respiratory failure (ARF) is the most common problem seen in the preterm and term infants admitted to neonatal intensive care units. Etiology is not uniform, and mostly depend on gestational age. For adequate treatment is certainly important to recognize and treat underlying disease, but at the same time, we have to supply adequate respiratory support, tissue perfusion and oxygen deliveries. For a good outcome we need reliable estimation method for functional state of respiratory system, as well as monitoring the effects of treatment. Current assessment ARF is with blood gas, chest X-ray and Oxygenation index (OI). OI is quite aggressive assessment method for neonates, because it involves arterial blood sampling. Promoted in recent studies, Oxygen saturation index (OSI) measured by pulse oximetry, attempts to objectively score respiratory disease with parameters available non-invasively. The aim of our research is to evaluate correlation between OSI and OI in neonates with ARF requiring mechanical ventilation. Material and methods: In a retrospective cohort study 101 neonates were selected, treated at the Department of intensive therapy and care, Pediatric clinic of Tuzla, due to ARF requiring mechanical ventilation.We reviewed data such as gestational age, birth weight, gender, Apgar scores, values of Score for Neonatal Acute Physiology-Perinatal Extension, all the parameters from the arterial blood gas analysis, pulse oximetry values, Oxygenation Index and Oxygenation Saturation Index, that were calculated by the formulas. OSI and OI were calculated and correlated. Mean values of OSI and OI correlated with Pearson's coefficient of 0.76; p < 0.0001 (95% CI = 0.66-0.83). OSI correlated with SNAP-PE with Pearson's coefficient of 0.52; p < 0.0001 (95% CI = 0.36-0.65). Comparing the values of OSI between patients who died and those who survived, we fo-und that OSI correlated with the outcome with Spearman's coefficient of -0.47; p < 0.0001 (95% CI = -0.16 --0.31). Bland-Altman plot confirmed correlation between OSI and OI in mean values, identifying discrepancy between two indices for extreme values. In conclusion, OSI correlates significantly with OI in infants with respiratory failure. This noninvasive method of oxygenation assessment, utilizing pulse oximetry, can be used to assess the severity of ARF and mortality risk in neonates.

Introduction:The association of acute intermitetn porphyria (AIP) with pregnancy and as a cause of spontaneous abortion is rare. Aim: To show a case of AIP known before pregnancy in a patient who had a spontaneous abortion. Case report: A gynecologist examined 26-yearold patient in the 8th week of gestation, due to initial spontaneous abortion, abdominal pain, constipation, muscle weakness, vomiting and dark colour of urine. Her therapy was dydrogesterone. In consultation with an anesthesiologist, a short intravenous anesthesia, vacuum aspiration, and curettage were performed.During hospitalization, the patient ceased to take harmful drugs and she was given haemarginate, glucose and symptomatic drugs, and she recovered completely. Conclusion: Treatment of threatened spontaneous abortion in AIP remains the subject of dilemma and controversy, and future research is needed.

Massive pulmonary hemorrhage (MPH) in neonates is a severe condition followed by many complications and associated with a high mortality rate. The aim of this study was to present the incidence, possible risk factors, and short-term outcome of neonatal MPH in Tuzla Canton. We retrospectively analyzed data on neonates with MPH from January 2015 to December 2017. On statistical analysis, standard methods of descriptive statistics were used. During the three-year study period, 16 neonates developed MPH, 5 (31.25%) male and 11 (68.75%) female. Their mean gestational age was 29.48±2.21 weeks and mean birth weight 1276.69±387.65 grams. Seven (43.75%) neonates survived and 9 (56.25%) died. Significant differences between the two outcome groups (survivors/died) were found in gestational age, birth weight, birth length, 5-minute Apgar score, and length of treatment at the Neonatal Intensive Care Unit. In Tuzla Canton, MPH occurred mainly in preterm neonates requiring mechanical ventilation, with the incidence of 1.91% of total premature births. The short-term outcome was uncertain, with a high mortality rate of 56.25%. Lower gestational age, lower birth weight, lower birth length and lower 5-minute Apgar score were confirmed as risk factors for poor short-term outcome.

&lt;p&gt;&lt;strong&gt;Aim &lt;br /&gt;&lt;/strong&gt;To compare maternal, foetal and neonatal characteristics, and perinatal outcome of preterm and term deliveries in twins pregnancies in order to improve perinatal care in Bosnia and Herzegovina. &lt;br /&gt;&lt;strong&gt;Methods&lt;br /&gt;&lt;/strong&gt; This retrospective cohort study included pregnant women with twin pregnancy who delivered during the period between 1 January 2012 and 31 December 2018 at the Clinic for Gynaecology and Obstetrics, University Clinical Centre Tuzla. &lt;br /&gt;&lt;strong&gt;Results&lt;/strong&gt; &lt;br /&gt;During the seven-year period 26 734 deliveries were recorded, out of which 362 (1.35 %) were twin pregnancies, 226 (62.4%) preterm and 136 (37.5%) term ones. In the preterm group 38 (16.8%) pregnancies were assisted medical reproduction, and 16 (11.7%) of those were in the term group. The average birth weight was significantly higher for the first twin in both groups (p&amp;lt;0.00001). Incipient intrauterine foetal asphyxia was more frequent in the preterm group (p&amp;lt;0.05). The most common indication for Caesarean section was abnormalities of foetal presentation and lie, 176 (68.2%) for the overall sample. &lt;br /&gt;&lt;strong&gt;Conclusion&lt;br /&gt;&lt;/strong&gt; Cornerstone of twin pregnancy antenatal care is to get correct data about amnionicity and chorionicity. Since majority of prenatal data did not have this information we call all obstetricians to declare about amnionicity and chorionicity in twin pregnancies during the first trimester ultrasound examination.&lt;/p&gt;