Papers by Andrijana Muller
BMC Pregnancy and Childbirth
Background Hypothermia during the newborn period is widely regarded as a major contributory cause... more Background Hypothermia during the newborn period is widely regarded as a major contributory cause of significant morbidity and mortality of newborn infants. Thermoprotective behaviours such as skin-to-skin care (SSC) or the use of appropriate devices have been recommended as simple tools for the avoidance of neonatal hypothermia. We examined the relation between the duration of skin-to-skin care and infant temperature change after birth in suboptimal delivery room temperatures. Methods We reviewed the medical charts of all vaginally born infants of gestational age ≥ 35 weeks born January-July 2018 and admitted to the well-baby nursery. After SSC was discontinued, the infant’s rectal temperature was measured to determine the frequency and severity of hypothermia. Results The charts of 688 vaginally born infants were examined. Our mean delivery room temperature was 21.7 (SD 2.2) °C, well below the WHO recommendation of 25 °C. After SSC 347 (50.4%) infants were normothermic (temperatur...
Psychiatria Danubina, 2021
Aim: A myriad of myths surround pregnancy, especially regarding the prediction of the sex of the ... more Aim: A myriad of myths surround pregnancy, especially regarding the prediction of the sex of the infant. Some of these myths and old wives' tales are, to this day, widespread among expectant parents. The objective of this study was to examine whether common pregnancy-related statements regarding foetal sex prediction vary between mothers of female and male infants. Methods: The questionnaire-based study was conducted from September 2017 to September 2018 at a well-baby nursery. Participants were mothers of infants (n = 350) admitted to the well-baby nursery with a singleton pregnancy and at > 36 weeks of gestation at birth. Results: We investigated a number of statements regarding foetal sex prediction. With the exception of one statement, there were no other differences between mothers of male and female infants. Pregnancy with a male foetus is associated with glossier hair during pregnancy. Women with female newborns reported glossier hair during pregnancy in 39.1% of cases...
Journal of Pediatric and Neonatal Individualized Medicine, 2019
Introduction: Bronchopulmonary dysplasia (BPD) is a significant cause of mortality and morbidity ... more Introduction: Bronchopulmonary dysplasia (BPD) is a significant cause of mortality and morbidity in preterm infants. The incidence of BPD varies widely between centers and is found in 20% to 40% of very low birth weight (VLBW) infants. Our work aimed to examine the incidence and risk factors for moderate and severe BPD in a population of VLBW infants. Materials and methods: Demographic data, risk factors, incidence and severity of BPD were analyzed for 178 VLBW infants treated in two Croatian perinatal regions (2 level III neonatal units, 2 level II neonatal units and 5 level I neonatal wards) in the period from January 1, 2014 to December 31, 2016. Results: The rate of BPD was 59.6% (106/178) which is significantly higher than reported earlier. Mild BPD accounted for 65.1% (69/106) and moderate/severe BPD is found in 34.9% (37/106) infants. Among infants with ≤ 28 weeks of gestation, the rate of moderate and severe BPD was 40.5% (30/74). Ultimate risk factors for the development of...
Biochemia medica, 2021
Women’s metabolism during pregnancy undergoes numerous changes that can lead to gestational diabe... more Women’s metabolism during pregnancy undergoes numerous changes that can lead to gestational diabetes mellitus (GDM). The cause and pathogenesis of GDM, a heterogeneous disease, are not completely clear, but GDM is increasing in prevalence and is associated with the modern lifestyle. Most diagnoses of GDM are made via the guidelines from the International Association of Diabetes and Pregnancy Study Groups (IADSPG), which involve an oral glucose tolerance test (OGTT) between 24 and 28 weeks of pregnancy. Diagnosis in this stage of pregnancy can lead to short- and long-term implications for the mother and child. Therefore, there is an urgent need for earlier GDM markers in order to enable prevention and earlier treatment. Routine GDM biomarkers (plasma glucose, insulin, C-peptide, homeostatic model assessment of insulin resistance, and sex hormone-binding globulin) can differentiate between healthy pregnant women and those with GDM but are not suitable for early GDM diagnosis. In this ...
Journal of Obstetrics and Gynaecology Research, 2021
The aim of research was to evaluate the maternal serum concentration of selected endogenous stero... more The aim of research was to evaluate the maternal serum concentration of selected endogenous steroid hormones during spontaneous parturition at term and to determinate their association with the need for oxytocin augmentation.
Acta Clinica Croatica, 2019
We investigated mortality, causes, timing and risk factors for death until hospital discharge in ... more We investigated mortality, causes, timing and risk factors for death until hospital discharge in very-low-birth-weight (VLBW) infants born in two Croatian perinatal care regions. This retrospective study included 252 live born VLBW infants. The mortality rate until hospital discharge was 30.5% (77/252). VLBW infants who died had by 4 weeks lower gestational age (GA) than surviving infants (median GA, 25 vs. 29 weeks), lower birth weight (BW) (mean BW, 756.4 vs. 1126.4 g), lower 5-minute Apgar score (median 5 vs. 8) and were more often resuscitated at birth (41.6 vs. 19.4%; p<0.001 all). Infants who survived were more often small-for-gestational age (SGA) (28.0 vs. 15.6%; p=0.04) and more often received continuous-positive-airway-pressure (CPAP) in delivery room (13.1 vs. 2.6%; p=0.01). Multivariate logistic regression revealed that parameters influencing death until hospital discharge were 5-minute Apgar score (OR 0.780, 95% CI 0.648-0.939) and higher Clinical Risk Index for Babies (CRIB) score (OR 1.677, 95% CI 1.456-1.931). ROC analysis showed that CRIB score (AUC 0.927, sensitivity 92.2, specificity 81.1; p<0.001) was the strongest predictor of death until hospital discharge. In infants who died within 12 hours, death was most commonly attributed to immaturity and in those surviving >12 hours to necrotizing enterocolitis.
Nutrients
This study aimed to investigate diet quality in healthy pregnant women based on the Na-to-K ratio... more This study aimed to investigate diet quality in healthy pregnant women based on the Na-to-K ratio from 24 h urine sample and food frequency questionnaire (FFQ), to compare dietary micro- and macronutrient intake with current nutritional recommendations (RDA), and to investigate whether gestational weight gain (GWG) is associated with Na-to-K ratio and diet quality during pregnancy in general. Sixty-four healthy pregnant women between 37 and 40 weeks of gestation participated in the study. Participants’ GWG, body composition, molar 24 h urine Na-to-K ratio, and FFQ data on average daily total energy, food groups, and micro-/macronutrient intake were obtained. A Na-to-K ratio of 2.68 (1.11–5.24) does not meet nutrition quality and is higher than the WHO recommendations due to excessive sodium and insufficient potassium intake. FFQ Na-to-K ratio was associated with a higher daily intake of soups, sauces, cereals, fats, and oils and a low intake of fruit and non-alcoholic beverages. A t...
Southeastern European medical journal, 2018
Aim: This study aimed to determine how delivery room resuscitation efforts influence admission te... more Aim: This study aimed to determine how delivery room resuscitation efforts influence admission temperatures in premature infants born before 32 weeks gestation. Methods: We retrospectively analyzed a cohort of premature infants born before 32 weeks gestation from January 2014 until December 2016. We compared the impact of resuscitation efforts performed in the delivery room on the admission temperature. Hypothermia was defined as a core temperature of less than 36.5°C on admission. The primary outcome was admission temperature in the Neonatal Intensive Care Unit. Secondary outcomes were Apgar scores in the first and fifth minute, pH on admission, respiratory distress syndrome requiring surfactant, persistent ductus arteriosus, necrotizing enterocolitis, late onset sepsis, kidney failure, intraventricular hemorrhage and death until hospital discharge. Exclusion criteria were chromosomal abnormalities, large congenital anomalies and etc. Results: We studied 147 infants born < 32 we...
Aim To investigate a potential of the clinical use of the soluble fms-like tyrosine kinase 1 (sFL... more Aim To investigate a potential of the clinical use of the soluble fms-like tyrosine kinase 1 (sFLT-1) to placental growth factor (PlGF) ratio from the perspective of a small hospital centre. Methods Maternal serum samples were analysed at 241/7-28 0/7, and 281/7-320/7 weeks of gestation. The level of sFLT-1 and PIGF was determined by immunoassay platform and used to calculate the sFLT-1/PIGF ratio in 35 pregnant women, and divided into subgroups according to preeclampsia occurrence at the time of delivery: preterm (≤37 weeks) or term (37-42 weeks'), and matched a control group. Results Patients in the preterm delivery group had a significantly higher incidence of intrauterine growth restriction, lower gestational age at the time of delivery, and lower infant birth weight compared to the other two groups. There was a negative correlation between the sFLT-1/PlGF ratio and GA and between the sFLT-1/ PlGF ratio and birth weight at the time of delivery. The value of the sFLT-1/PlGF r...
Revue Roumaine De Chimie, 2015
The aim of this study was to determine certain metals, metalloids and phosphorus in samples of wa... more The aim of this study was to determine certain metals, metalloids and phosphorus in samples of water from wells located in eastern Croatian zones in order to assess water quality and to monitor possible war consequences such as metal contamination. Inductively coupled plasma mass spectrometry (ICP-MS) was used to collect the results of the following elements: Al, As, B, Ba, Cd, Co, Cr, Cu, Fe, Hg, Li, Mn, Mg, Ni, P, Pb, Sb, Si, Sn, Sr, Tl, U, V and Zn. Although the results of this study confirmed that there is a significant environmental issue related to elevated values of arsenic (max. 250.40 μg L- 1), overall results did not show abnormalities in concentrations of monitored weapon related elements. Also, we have collected and analysed data for the Drava River, part of the Danube basin, which is partially the source of drinking water production. Eleven physicochemical parameters were analysed in order to assess the water quality characteristics of the Drava River water in the north...
Clinical Chemistry and Laboratory Medicine, 2017
Journal of Perinatal Medicine, 2017
Abstract: Objective: It is well accepted that adiposity in general is associated with significant... more Abstract: Objective: It is well accepted that adiposity in general is associated with significantly higher circulatory levels of different inflammatory markers. The aim of this study was to investigate whether such correlation between proinflammatory markers and body mass index (BMI) is present in pregnant women as well. Methods: 30 pregnant women in third trimester of pregnancy were included in the present study. They were categorized based on BMI in three groups: 6 patients with BMI 30 kg/m2 (BMI III). The inflammatory markers (high sensitive C reactive protein (hsCRP) and procalcitonin (PCT)) were measured between 28 1/7 and 32 0/7 weeks of gestation. Perinatal outcome was analysed in all participants. Results: There was no difference in age and smoking habits between all three grops of subjects. Authors found statistically significant difference in hsCRP mean values between groups: BMI I 4.637 mg/l, BMI II 5.720 mg/l ; BMI III 10.910 mg/l (P= 0.002). However, there was no statis...
Premature birth (prior to 37 weeks of gestation) is a big medical and socioeconomic problem. It a... more Premature birth (prior to 37 weeks of gestation) is a big medical and socioeconomic problem. It accounts for 8 - 12% of the total number of births, and apart from causing increased mortality of newborns, it is also the cause of increased morbidity. Fifteen million babies per year are born preterm. Despite the frequency, consequences and costs of premature delivery, very little has been done for preventing it, especially for preventing extremely premature deliveries (before the 28th gestation week). Etiology of premature labor is multifactorial, and includes pathophysiology, genetic and environmental factors. Recent scientific research shows that genetic factors, mostly present in the mother's genome, account for up to 40% of variation in the delivery time. It is believed that premature birth exhibits the same cascade of events like a normal birth, only it starts sooner. This process is controlled by a series of hormonal effects between the fetus, the placenta and the mother. One...
European Journal of Obstetrics & Gynecology and Reproductive Biology
Signa Vitae - A Journal In Intensive Care And Emergency Medicine
The optimal mode of delivery for very low birth weight (VLBW) infants remains controversial. Desp... more The optimal mode of delivery for very low birth weight (VLBW) infants remains controversial. Despite lacking evidence of benefits regarding neonatal outcomes, cesarean section delivery is becoming more prevalent, particularly in early gestational ages. In our retrospective, multicentr study data were collected for very low birth weight infants born in two Croatian perinatal regions in a 3-year period (2014.-2016.). The final cohort consisted of 255 very low birth weight infants. The rate of delivery via cesarean section was 74.1% (189/255) and is one of the highest reported in the literature so far. Infants born vaginally were born at an lower gestational age, had lower 1-and 5-minute Apgar scores, lower birth weights, and prognosis as expressed by higher Clinical risk index for babies (CRIB) scores and were more often born following chorioamnionitis and had higher mortality rate until 7 days of hospitalization. Univariate logistic regression analysis showed that cesarean section reduced the risk of death before 7 days of life (OR 0.34 95% CI 0.182-0.667). This significance was lost after multivariate analysis. In infants surviving after 7 days of hospitalization, rates of short-term neonatal morbidity (severe intracranial hemorrhage, cystic periventricular leukomalacia (cPVL), late-onset sepsis, necrotizing enterocolitis, kidney injury and retinopathy of prematurity requiring interventions) were not significant when comparing infants born vaginally and those born following cesarean section.
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Papers by Andrijana Muller