The normal retinal development is interrupted by preterm birth and a retinopathy of prematurity (ROP) may develop as its consequence. ROP is characterised by aberrant vessel formation in the retina as a response to multiple risk factors influencing the process of retinal angiogenesis. Insulin-like growth factor I (IGF -1) and vascular endothelial growth factor (VEGF) play an important role in the process of normal retinal vascularisation. Insufficient nutrition during the first 4 postnatal weeks results in low serum levels of IGF-1, which is essential for correct retinal vessels formation, ensuring survival of the newly formed endothelial cells. Low IGF-1 level results in stop of angiogenesis in the retina, leaving it avascular and prompting the onset of ROP. Keeping the newborns in a positive energetic balance by providing enough nutrients and energy has a beneficial impact on their growth, neurodevelopment and decreased incidence of ROP. The best way to achieve this is the early parenteral nutrition with the high content of nutrients combined with early enteral feeding by the own mother's breast milk. Multiple studies confirmed the safety and efficacy of early aggressive nutrition but information about its long-term effects on the metabolism, growth and development is stil needed., N. Lenhartova, K. Matasova, Z. Lasabova, K. Javorka, A. Calkovska., and Obsahuje bibliografii
Východiskem článku je situace viability. Ta je analyzována jako sémantický a medicínský koncept a jsou charakterizovány důsledky, které má klinický status extrémně nezralého novorozence (dítěte narozeného na hranici viability) pro etické uvažování a pro rozhodování o odpovídající lékařské péči, když není zohledněno pouze přežití extrémně nezralého novorozence ale rovněž různá úroveň poškození způsobeného lékařským zásahem. Článek se dále zabývá medicínskou nejistotou, jež je typická pro rozhodování o zdravotní péči o extrémně nezralé novorozence. Následně se zaměřuje na nejistotu etickou, která vyplývá z nejistoty medicínské. V závěru pojednání jsou navrženy způsoby, jak postupovat, rozhodovat a konat v situaci etických dilemat zachraňování dětí narozených na samé hranici viability. and The paper departs from viability, analysing viability as semantic and medical concept and characterizing consequences that clinical status of an extremely preterm newborn (neonate born at the edge of viability) has for ethical considerations and decisions about the proper medical care – when not only survival of the extremely preterm neonate but also diverse level of medical harm to the infant are at the stake. Coming from medical uncertainty, typical for the extremely premature newborns, the paper focuses on moral uncertainty caused my medical uncertainty. Finally the paper brings some modi procedendi for ethical dilemmas of saving infants born at the edge of viability.
Prematurely erupted teeth are rare in fullterm neonates and extremely rare in prematurely delivered infants. The aim of this study was to present macroscopic and scanning electron microscopy (SEM) investigations of prematurely erupted primary teeth of preterm very low birthweight (VLBW) and extremely low birthweight (ELBW) infants. Three preterm VLBW and ELBW infants with prematurely erupted lower incisors were examined. The dental examination assessed the type, location, clinical appearance, and degree of mobility of the prematurely erupted teeth. The structural appearance of enamel and dentin of three extracted and longitudinally sectioned prematurely erupted teeth was investigated with scanning electron microscopy (SEM). Lower incisors were rootless with hypermobility. The surface of enamel of the prematurely erupted primary teeth was hypoplastic and hypomineralized and had a typical “honeycomb” appearance in SEM. The aprismatic type of enamel was visible in some regions. The neonatal line separating the layer of prenatal enamel from postnatal enamel was observed. The enamel prisms were interconnected by interprismatic substances, and cross-striations of prisms were visible. Dentin presented a typical tubular character. The dentinal layer near the enamel dentin junction had Y-shaped branching of dentinal tubules. On the pulpal side, dentin had a globular character. The macroscopic and SEM investigations particularly revealed alterations in enamel, while the dentin of neonatal teeth had a nearly normal appearance.