Sažetak. Cerebralna paraliza je klinički entitet koji karakterizira poremećaj pokreta i položaja uzrokovan neprogresivnim oštećenjem nezrelog mozga. Mnogo je etioloških faktora zbog kojih dolazi do oštećenja mozga koje može uzrokovati cerebralnu paralizu. Posljedice oštećenja utječu na motoričku funkciju te mišićno-koštani i kognitivni razvoj, a javlja se i niz drugih pridruženih zdravstvenih poteškoća. Kada se govori o cerebralnoj paralizi uvijek treba naglasiti da cerebralna paraliza predstavlja ne samo medicinski problem, nego i psihološki i socijalni problem. Dijagnoza se postavlja kod djece kod koje je uočen usporeni razvoj motorike, koji se potvrđuje nalazima magnetske rezonancije. Terapija djeteta s cerebralnom paralizom usmjerena je na ostvarivanje zadanog cilja. Dva glavna cilja su smanjiti komplikacije uzrokovane cerebralnom paralizom i poboljšati sposobnost usvajanja novih vještina. Dodatni ciljevi su edukacija roditelja, smanjenje tjelesnih deformacija i poboljšanje pokretljivosti. Cerebralna paraliza zahtijeva interdisciplinarni pristup te ima velik utjecaj i na dijete i na čitavu obitelj i život njenih članova. Svaki terapijski pristup bazira se na individualnom pristupu. Vrlo je bitno terapiju započeti što ranije jer ranija terapija olakšava razvoj djeteta i pridonosi boljem ishodu terapije i kvaliteti života. Terapija cerebralne paralize ne treba biti usmjerena samo na motoričke tretmane, već i na tretmane i drugih poremećaja od kojih dijete pati. Postoji niz terapijskih sustava koji se primjenjuju u radu s djecom s cerebralnom paralizom. Rijetko se kad terapija oslanja na samo jedan, a najčešće se primjenjuje kombinacija terapijskih postupaka. Takav pristup omogućava fleksibilnost i individualizaciju, kako bi se ostvarili ciljevi postavljeni za dijete i obitelj.Abstract. Cerebral palsy is a clinical entity characterized by disorder of movement and posture caused by a non-progressive injury to the immature brain. There are many etiological factors that may cause brain injury that result in cerebral palsy. The consequences of brain injury may have an effect on motor function, musculoskeletal and cognitive development as well as on a range of other associated health issues. Also, when it comes to cerebral palsy, it should always be noted that it is not merely about a medical problem, but also the psychological and social components have to be taken into account. Diagnosis is made in children with slow motor development and is comfimed with findings from magnetic resonance imaging. In children with cerebral palsy, the treatment is aimed at achieving two main goals: reduce complications of cerebral palsy and improve the ability to acquire new skills. Additional goals are represented by parent education, reduction of body deformations and mobility improvement. Cerebral palsy has a major impact on the child, the whole family and their life, thus an interdisciplinary approach is required. It is important to begin the therapy as early as possible in order to facilitatee the patient's development and contr...

Aim: To summarize our five-year experience in management of premature infants at our second level neonatal facility. Patients and methods: This prospective birth cohort study was performed at the Division of Neonatology (level 2), Department of Paediatrics, General hospital Pula during a five-year-period (January 1st 2012 – December 31st 2016). The study population included all live-born neonates born between 22nd and 37th gestational week. Results: During the above mentioned five-year-period, 289 premature infants were born at General Hospital Pula. One-hundred and sixty seven (58%) neonates were delivered vaginally and 122 (42%) were delivered by caesarean section. Nineteen (7%) neonates were born after in vitro fertilization. Infants were mostly male (N=167; 58%), and appropriate for gestational age (N=240; 83%). Also, the infants belonged mostly to the late-preterm group (N=245; 85%). Thirty-three premature infants (11%) were transferred to a tertiary paediatric centre and five neonates died (2%). The overall cost of hospital stay for hospitalized premature infants was 2,517,000 Croatian kunas (cost for one patient: median 4800, range 3,225-53,325); in euros, it was 335,600 (cost for one patient: median 640, range 430-7,110) respectively. The overall hospital stay was 10.01±8.30 days (median 8.00, range 1.00-67.00). Conclusion: Despite the great development of neonatal intensive care, the best prevention of complications related to prematurity is to prevent preterm labour.

Cerebralna paraliza najčešći je uzrok trajnih i teških motoričkih oštećenja u djece. Smatra se posljedicom oštećenja nezrelog mozga ili mozga u razvoju. U terminske novorođenčadi etiologija je još i danas nedovoljno poznata i razlikuje se od etiologije CP-a u prijevremeno rođene djece. Prikazana je etiologija i rizični čimbenici za razvoj CP-a u terminske novorođenčadi rođene i/ili liječene u KBC-u Rijeka od 2002. do 2013. Udio terminske novorođenčadi u skupini djece sa CP-om iznosio je 40%, uz najvišu zastupljenost postnatalne etiologije od 47%, za razliku od drugih autora koji navode prenatalnu etiologiju vodećom. Razlog tome može biti i primjena suvremene klasifikacije i podjele CP-a. Intrapartalna etiologija nađena je u 18%, a prenatalna u 35% slučajeva. U djece s nepoznatom etiologijom nađeni su rizični čimbenici tijekom porođaja koji mogu upućivati na intrapartalnu etiologiju, čime bi se povećao njen udio u ukupnoj etiologiji CP-a. Radi eventualne prevencije potrebna su daljnja ciljana istraživanja o etiologiji CP-a u terminske novorođenčadi, služeći se jasnom klasifikacijom i definicijom CP-a. Ključne riječi: Cerebralna Paraliza; Postnatalno; Prenatalno; rizični čimbeniCi 1 zavod za dječju neurologiju i dječju psihijatriju Klinike za pedijatriju, KbC rijeka, referentni centar ministarstva zdravstva za epilepsije i konvulzivne bolesti razvojne dobi 2 medicinski fakultet sveučilišta u rijeci 3 odjel neonatologije, Klinika za ginekologiju i porodništvo, KbC rijeka 4 zavod za fizikalnu i rehabilitacijsku medicinu, KbC rijeka Adresa za dopisivanje:Cerebral palsy is the most common cause of permanent and severe motor impairment in children. It is considered as a consequence of damage to immature or developing brain. The aetiology in infants born at term is still mostly unknown and differs from the aetiology in premature infants. We present aetiology and risk factors for CP in infants born at term and/or treated at Rijeka University Hospital Centre from 2002 to 2013. Infants born at term comprised about 40% of the children with CP, with the highest contribution of postnatal aetiology (47%), unlike other authors who cite prenatal aetiology as the leading one. The modern definition and classification of CP may be the reason for this observation. Intrapartum aetiology was found in 18% and prenatal in 35% of cases. In children with undetermined aetiology, most risk factors were found during birth, which may indicate intrapartum aetiology, and thus the increase in the percentage of intrapartum aetiology in the overall aetiology of CP. Aiming at possible prevention, additional research into CP aetiology in infants born at term is required using clear definition and classification of CP.