Iwona Maruniak-chudek - Academia.edu (original) (raw)
Papers by Iwona Maruniak-chudek
Diagnostics
Open spina bifida is one of the most common congenital defects of the central nervous system. Ope... more Open spina bifida is one of the most common congenital defects of the central nervous system. Open fetal surgery, which is one of the available therapeutic options, remains the gold standard for prenatal repairs. Fetoscopic closure may lower the number of maternal complications associated with open fetal surgery. Regardless of the approach, the outcome may be compromised by the development of tethered spinal cord (TSC) syndrome. At 24.2 weeks of gestation, a primipara was admitted due to fetal myelomeningocele and was deemed eligible for fetoscopic repair. Fetal surgery was performed at 25.0 weeks of gestation. It was the first complete untethering of the spinal cord and anatomic reconstruction (dura mater, spinal erectors, skin) achieved during a fetoscopic repair of spina bifida. Cesarean section due to placental abruption was performed at 31.1 weeks of gestation. VP shunting, with no need for revision, was performed at 5 weeks postdelivery due to progressing ventriculomegaly. No ...
Pediatric Nephrology, 2004
Fetal Diagnosis and Therapy
Journal of Ultrasound in Medicine
Objectives-To evaluate normative sonographic measurements of the inferior vena cava (IVC), aorta ... more Objectives-To evaluate normative sonographic measurements of the inferior vena cava (IVC), aorta (Ao), and IVC/Ao ratio in the first 2 days of life in term neonates. Methods-We prospectively observed 200 term (more than 36 and 6/7 weeks of gestation), single, healthy neonates born in a city hospital. The exclusion criteria were congenital abnormalities, an Apgar score of less than 8, and hyperbilirubinemia requiring phototherapy. Maximum IVC (distal to the hepatic-IVC junction) and Ao (above the superior mesenteric artery) diameters were measured in the first 2 days of life in the longitudinal plane. Neonatal weight loss was calculated as a percentage lost from birth weight (BW). Results-A total of 200 (50% born vaginally, 53% male) neonates were enrolled. Correlations between IVC and aortic diameters as a function of gestational age, method of birth, weight loss, and body surface area (BSA) were calculated using the Spearman's rank correlation coefficient. The correlation coefficients were statistically significant for the IVC (P 5 .017) and Ao (P 5 .006) abdominal diameters versus gestational age. The Ao diameter correlated with BSA (P 5 .0001). In neonates with weight loss less than 8% of BW, the IVC/Ao ratio remained constant at 0.62 (95% confidence interval, 0.60-0.63). Conclusions-Sonographic measurements of IVC and Ao maximum diameters in term neonates suggests a significant positive correlation among gestational age, BSA, and IVC and Ao diameters. The IVC/Ao ratios remain constant over 48 hours after birth in neonates with weight loss up to 8% of BW, and appear to be lower than previously reported ratios for healthy children.
Disease Markers
Introduction. Zonulin (ZO), a new diagnostic biomarker of intestinal permeability, was tested in ... more Introduction. Zonulin (ZO), a new diagnostic biomarker of intestinal permeability, was tested in newborns presenting symptoms of infection and/or inflammation of the gut or being at risk of intestinal pathology. Material and Methods. Serum ZO was assessed in 81 newborns diagnosed with sepsis, necrotizing enterocolitis (NEC), rotavirus infection, and gastroschisis, also in extremely low gestational age babies, and in controls (healthy newborns). ZO concentration was compared to C-reactive protein (CRP) and procalcitonin (PCT) values, leucocyte and platelet count, basic demographic data, and the value of the Neonatal Therapeutic Intervention Scoring System (NTISS). Results. Median values of ZO were markedly higher in groups with rotavirus infection and gastroschisis (36.0 (1-3Q: 26.0–43.2) and 20.3 (1-3Q: 17.7–28.2) ng/ml, resp.) versus controls (3.5 (1-3Q: 2.7–4.8) ng/ml). Its concentration in the NEC group was twice as high as in controls but did not reach statistical significance. ...
Medycyna doświadczalna i mikrobiologia, 2004
The aim of the study was to examine the digestive tract colonisation of the newborns by multiple ... more The aim of the study was to examine the digestive tract colonisation of the newborns by multiple drug resistant bacteria during hospitalization. On the day of admission, after 5 days of hospitalization and at the day of discharge swabs from the anus of the 31 newborns hospitalized in OITiPN were taken and cultured on nutrient and selective media for staphylococci, enterococci, gram negative bacilli and fungi. Susceptibility to antibiotics of bacteria was determined, with giving attention to such resistance mechanisms as: methicillin resistant staphylococci (MRS), high level aminoglycoside resistant (HLAR) and vancomycin resistant enterococci (VRE) and the production of extended spectrum beta-lactamases (type ESBL) by gram negative bacilli. On the day of admission in 7 newborns methicillin resistant staphylococci (MRSCN) were grown in 24 no multiple drug resistant bacteria were found. Among those in 23 already after 5 days of hospitalization, colonization by multiple drug resistant s...
Tsai/Microdialysis, 2011
Page 1. 12 Applications of Microdialysis in Pharmaceutical Science, First Edition. Edited by Tung... more Page 1. 12 Applications of Microdialysis in Pharmaceutical Science, First Edition. Edited by Tung-Hu Tsai. © 2011 John Wiley & Sons, Inc. Published 2011 by John Wiley & Sons, Inc. 359 MICRODIALYSIS AS A MONITORING SYSTEM FOR HUMAN DIABETES ...
Journal of Maternal-Fetal and Neonatal Medicine, 2013
The aim of this study was a comparison of the outcomes of intrauterine myelomeningocele (MMC) rep... more The aim of this study was a comparison of the outcomes of intrauterine myelomeningocele (MMC) repairs (IUMR) in type II Chiari malformation (II CM) fetuses with clinical data of newborns and infants operated on postnatally. The study group (SG) comprised 46 pregnant women whose type II CM children underwent IUMR, while 47 pregnant women whose type II CM children were operated on postnatally constituted the control group (CG). A total of 24 SG and 20 CG patients reached the endpoint of the study. High incidence of prelabor rupture of membranes (24 (52.2%), CI: 3.74 (1.69-8.26) (p < 0.001) was noted in the group of prenatal surgeries as compared to controls. The need for ventriculoperitoneal shunt implantation was statistically significantly lower (p < 0.008) in the group of children after IUMR as compared to controls (5 (27.8%) and 16 (80%), respectively, CI: 0.35 (0.16-0.75). None of the postnatally treated CG children can walk without adaptive equipment. In contrast, two children from the SG (2 (11.1%) CI: 1.86 (1.00-3.48) p < 0.05) are able to walk independently. Prenatal MMC closure significantly lowers further adverse evolution of the II CM. Further studies are needed, especially on preventive measures for preterm labor and iatrogenic preterm prelabor rupture of membranes (iPPRM) in the postoperative course of IUMR.
Annales Academiae Medicae Silesiensis
WstępNoworodki z wrodzoną wadą serca (WWS) wymagają ostrożnej terapii płynami z uwagi na ryzyko w... more WstępNoworodki z wrodzoną wadą serca (WWS) wymagają ostrożnej terapii płynami z uwagi na ryzyko wystąpienia niewydolności krążenia. Rutynowe badania laboratoryjne nie są optymalnym narzędziem w identyfikacji stanu przewodnienia i dlatego konieczne są poszukiwania nowych markerów. Kopeptyna (CTproAVP) może być jednym z nich. Celem pracy była analiza wpływu aktualnie obowiązującego protokołu nawadniania noworodków z WWS na homeostazę wolemii z wykorzystaniem CTproAVP.Materiał i metodyDo badania włączono 10 noworodków z WWS hospitalizowanych na oddziale intensywnej terapii noworodka przed zabiegiem kardiochirurgicznym. Cztery z nich prezentowały objawy niewydolności oddechowej, a wszystkie z wyjątkiem dwóch otrzymywały alprostadil. Postępowanie kliniczne było rutynowe, z wyjątkiem pomiaru CTproAVP w pierwszych pięciu dniach życia wraz z oceną osmolalności surowicy i moczu. Podaż płynów mieściła się w zakresach normy dla wieku. Grupę kontrolną stanowiło 200 zdrowych donoszonych noworodk...
Postępy Higieny i Medycyny Doświadczalnej, 2015
Stress stimuli, including diseases, disturb homeostasis of the body and enhance secretion of vari... more Stress stimuli, including diseases, disturb homeostasis of the body and enhance secretion of various hypothalamus, pituitary and adrenal gland hormones. One of the main hypothalamic hormones secreted in stress conditions is arginine vasopressin (AVP). Vasopressin concentration in the blood reflects the severity of disease and disorders of blood volume. Measurement of vasopressin is difficult and subjected to considerable laboratory error because of the short half-life in serum and its instability in withdrawn blood samples. This hormone and copeptin are peptides produced during the cleavage of a larger precursor polypeptide: pre-provasopressin. Both peptides are formed in equimolar amounts. Copeptin is a more stable peptide, measurement of which can be performed with higher accuracy. This paper presents the importance of copeptin as a marker of stress, with particular emphasis on the neonatal period, analyzing the impact of gestational age and the route of delivery. Its potential application for assessing the degree of hydration in the adaptation period is also discussed.
Postȩpy higieny i medycyny doświadczalnej (Online), 2012
Several studies have claimed that the estimation of serum cystatin C could be a better marker of ... more Several studies have claimed that the estimation of serum cystatin C could be a better marker of kidney excretory function than serum creatinine. However, its role in the diagnosis of reduced kidney function was not unquestionably confirmed. The aim of this study was to analyze the concentrations of serum cystatin C in neonates with sepsis. Thirty-two neonates (gestational age from 34 to 40 weeks) admitted to the NICU during the first 14 days of life were enrolled. Serum cystatin C concentrations were estimated by ELISA during three successive days in neonates treated for infection. The study group consisted of 9 newborns with sepsis, 14 with severe sepsis and 9 with septic shock. At the beginning of the observational period the mean serum concentration of cystatin C in the study group was 1.35 mg/L (95% CI 1.20-1.49). Surprisingly, the lowest concentration of cystatin was observed in patients with septic shock (1.23 mg/L; 95%CI 0.92-1.54) within the observation period. Higher conce...
Pheochromocytoma occurs with a frequency estimated at 2-7 per 100 000 pregnant women. Unrecognize... more Pheochromocytoma occurs with a frequency estimated at 2-7 per 100 000 pregnant women. Unrecognized, and thus untreated pheochromocytoma is associated with very high (40-50%) maternal and fetal mortality. Pheochromocytoma occurs sporadically or as a family trait. Its presence should be suspected in women with paroxysmal or established hypertension, especially before the 20th week of pregnancy, accompanied by headaches and palpitations, and excessive sweating, muscle tremors, vomiting, anxiety, vasomotor disturbances and blurred vision. The variety of clinical presentations and rarity are the cause of not including the disease in differential diagnosis of hypertension in pregnancy. Biochemical tests are essential in the diagnosis of pheochromocytoma, and involving the assessment of methoxycatecholamine urinary excretion. The second step in the diagnostics is magnetic resonance imaging of adrenal glands. Adrenalectomy is the treatment of choice for pheochromocytoma with adrenal locatio...
Ginekologia polska, 2011
Together with the prolongation and improving the quality of life of young women with chronic rena... more Together with the prolongation and improving the quality of life of young women with chronic renal failure (CRF), procreation becomes an important issue. Pregnancies in women on renal replacement therapy are associated with an increased risk of health complications, both for mothers and for fetuses. Medical management of pregnant women with CRF is a great challenge and requires a close co-operation of nephrologists, transplantologists, gynecologists and neonatologists. The complexity of problems in these particular pregnancies has urged us to describe the case of a woman with CRF who successfully delivered two babies. We also review the current state of knowledge on the topic. The first pregnancy five years after renal transplantation, was completed with the delivery of term newborn with Tetralogy of Fallot. Also the second pregnancy on hemodialysis therapy was finished by the birth of a healthy neonate at term. The described case indicates that the gynecologists should be prepared ...
Diagnostics
Open spina bifida is one of the most common congenital defects of the central nervous system. Ope... more Open spina bifida is one of the most common congenital defects of the central nervous system. Open fetal surgery, which is one of the available therapeutic options, remains the gold standard for prenatal repairs. Fetoscopic closure may lower the number of maternal complications associated with open fetal surgery. Regardless of the approach, the outcome may be compromised by the development of tethered spinal cord (TSC) syndrome. At 24.2 weeks of gestation, a primipara was admitted due to fetal myelomeningocele and was deemed eligible for fetoscopic repair. Fetal surgery was performed at 25.0 weeks of gestation. It was the first complete untethering of the spinal cord and anatomic reconstruction (dura mater, spinal erectors, skin) achieved during a fetoscopic repair of spina bifida. Cesarean section due to placental abruption was performed at 31.1 weeks of gestation. VP shunting, with no need for revision, was performed at 5 weeks postdelivery due to progressing ventriculomegaly. No ...
Pediatric Nephrology, 2004
Fetal Diagnosis and Therapy
Journal of Ultrasound in Medicine
Objectives-To evaluate normative sonographic measurements of the inferior vena cava (IVC), aorta ... more Objectives-To evaluate normative sonographic measurements of the inferior vena cava (IVC), aorta (Ao), and IVC/Ao ratio in the first 2 days of life in term neonates. Methods-We prospectively observed 200 term (more than 36 and 6/7 weeks of gestation), single, healthy neonates born in a city hospital. The exclusion criteria were congenital abnormalities, an Apgar score of less than 8, and hyperbilirubinemia requiring phototherapy. Maximum IVC (distal to the hepatic-IVC junction) and Ao (above the superior mesenteric artery) diameters were measured in the first 2 days of life in the longitudinal plane. Neonatal weight loss was calculated as a percentage lost from birth weight (BW). Results-A total of 200 (50% born vaginally, 53% male) neonates were enrolled. Correlations between IVC and aortic diameters as a function of gestational age, method of birth, weight loss, and body surface area (BSA) were calculated using the Spearman's rank correlation coefficient. The correlation coefficients were statistically significant for the IVC (P 5 .017) and Ao (P 5 .006) abdominal diameters versus gestational age. The Ao diameter correlated with BSA (P 5 .0001). In neonates with weight loss less than 8% of BW, the IVC/Ao ratio remained constant at 0.62 (95% confidence interval, 0.60-0.63). Conclusions-Sonographic measurements of IVC and Ao maximum diameters in term neonates suggests a significant positive correlation among gestational age, BSA, and IVC and Ao diameters. The IVC/Ao ratios remain constant over 48 hours after birth in neonates with weight loss up to 8% of BW, and appear to be lower than previously reported ratios for healthy children.
Disease Markers
Introduction. Zonulin (ZO), a new diagnostic biomarker of intestinal permeability, was tested in ... more Introduction. Zonulin (ZO), a new diagnostic biomarker of intestinal permeability, was tested in newborns presenting symptoms of infection and/or inflammation of the gut or being at risk of intestinal pathology. Material and Methods. Serum ZO was assessed in 81 newborns diagnosed with sepsis, necrotizing enterocolitis (NEC), rotavirus infection, and gastroschisis, also in extremely low gestational age babies, and in controls (healthy newborns). ZO concentration was compared to C-reactive protein (CRP) and procalcitonin (PCT) values, leucocyte and platelet count, basic demographic data, and the value of the Neonatal Therapeutic Intervention Scoring System (NTISS). Results. Median values of ZO were markedly higher in groups with rotavirus infection and gastroschisis (36.0 (1-3Q: 26.0–43.2) and 20.3 (1-3Q: 17.7–28.2) ng/ml, resp.) versus controls (3.5 (1-3Q: 2.7–4.8) ng/ml). Its concentration in the NEC group was twice as high as in controls but did not reach statistical significance. ...
Medycyna doświadczalna i mikrobiologia, 2004
The aim of the study was to examine the digestive tract colonisation of the newborns by multiple ... more The aim of the study was to examine the digestive tract colonisation of the newborns by multiple drug resistant bacteria during hospitalization. On the day of admission, after 5 days of hospitalization and at the day of discharge swabs from the anus of the 31 newborns hospitalized in OITiPN were taken and cultured on nutrient and selective media for staphylococci, enterococci, gram negative bacilli and fungi. Susceptibility to antibiotics of bacteria was determined, with giving attention to such resistance mechanisms as: methicillin resistant staphylococci (MRS), high level aminoglycoside resistant (HLAR) and vancomycin resistant enterococci (VRE) and the production of extended spectrum beta-lactamases (type ESBL) by gram negative bacilli. On the day of admission in 7 newborns methicillin resistant staphylococci (MRSCN) were grown in 24 no multiple drug resistant bacteria were found. Among those in 23 already after 5 days of hospitalization, colonization by multiple drug resistant s...
Tsai/Microdialysis, 2011
Page 1. 12 Applications of Microdialysis in Pharmaceutical Science, First Edition. Edited by Tung... more Page 1. 12 Applications of Microdialysis in Pharmaceutical Science, First Edition. Edited by Tung-Hu Tsai. © 2011 John Wiley & Sons, Inc. Published 2011 by John Wiley & Sons, Inc. 359 MICRODIALYSIS AS A MONITORING SYSTEM FOR HUMAN DIABETES ...
Journal of Maternal-Fetal and Neonatal Medicine, 2013
The aim of this study was a comparison of the outcomes of intrauterine myelomeningocele (MMC) rep... more The aim of this study was a comparison of the outcomes of intrauterine myelomeningocele (MMC) repairs (IUMR) in type II Chiari malformation (II CM) fetuses with clinical data of newborns and infants operated on postnatally. The study group (SG) comprised 46 pregnant women whose type II CM children underwent IUMR, while 47 pregnant women whose type II CM children were operated on postnatally constituted the control group (CG). A total of 24 SG and 20 CG patients reached the endpoint of the study. High incidence of prelabor rupture of membranes (24 (52.2%), CI: 3.74 (1.69-8.26) (p < 0.001) was noted in the group of prenatal surgeries as compared to controls. The need for ventriculoperitoneal shunt implantation was statistically significantly lower (p < 0.008) in the group of children after IUMR as compared to controls (5 (27.8%) and 16 (80%), respectively, CI: 0.35 (0.16-0.75). None of the postnatally treated CG children can walk without adaptive equipment. In contrast, two children from the SG (2 (11.1%) CI: 1.86 (1.00-3.48) p < 0.05) are able to walk independently. Prenatal MMC closure significantly lowers further adverse evolution of the II CM. Further studies are needed, especially on preventive measures for preterm labor and iatrogenic preterm prelabor rupture of membranes (iPPRM) in the postoperative course of IUMR.
Annales Academiae Medicae Silesiensis
WstępNoworodki z wrodzoną wadą serca (WWS) wymagają ostrożnej terapii płynami z uwagi na ryzyko w... more WstępNoworodki z wrodzoną wadą serca (WWS) wymagają ostrożnej terapii płynami z uwagi na ryzyko wystąpienia niewydolności krążenia. Rutynowe badania laboratoryjne nie są optymalnym narzędziem w identyfikacji stanu przewodnienia i dlatego konieczne są poszukiwania nowych markerów. Kopeptyna (CTproAVP) może być jednym z nich. Celem pracy była analiza wpływu aktualnie obowiązującego protokołu nawadniania noworodków z WWS na homeostazę wolemii z wykorzystaniem CTproAVP.Materiał i metodyDo badania włączono 10 noworodków z WWS hospitalizowanych na oddziale intensywnej terapii noworodka przed zabiegiem kardiochirurgicznym. Cztery z nich prezentowały objawy niewydolności oddechowej, a wszystkie z wyjątkiem dwóch otrzymywały alprostadil. Postępowanie kliniczne było rutynowe, z wyjątkiem pomiaru CTproAVP w pierwszych pięciu dniach życia wraz z oceną osmolalności surowicy i moczu. Podaż płynów mieściła się w zakresach normy dla wieku. Grupę kontrolną stanowiło 200 zdrowych donoszonych noworodk...
Postępy Higieny i Medycyny Doświadczalnej, 2015
Stress stimuli, including diseases, disturb homeostasis of the body and enhance secretion of vari... more Stress stimuli, including diseases, disturb homeostasis of the body and enhance secretion of various hypothalamus, pituitary and adrenal gland hormones. One of the main hypothalamic hormones secreted in stress conditions is arginine vasopressin (AVP). Vasopressin concentration in the blood reflects the severity of disease and disorders of blood volume. Measurement of vasopressin is difficult and subjected to considerable laboratory error because of the short half-life in serum and its instability in withdrawn blood samples. This hormone and copeptin are peptides produced during the cleavage of a larger precursor polypeptide: pre-provasopressin. Both peptides are formed in equimolar amounts. Copeptin is a more stable peptide, measurement of which can be performed with higher accuracy. This paper presents the importance of copeptin as a marker of stress, with particular emphasis on the neonatal period, analyzing the impact of gestational age and the route of delivery. Its potential application for assessing the degree of hydration in the adaptation period is also discussed.
Postȩpy higieny i medycyny doświadczalnej (Online), 2012
Several studies have claimed that the estimation of serum cystatin C could be a better marker of ... more Several studies have claimed that the estimation of serum cystatin C could be a better marker of kidney excretory function than serum creatinine. However, its role in the diagnosis of reduced kidney function was not unquestionably confirmed. The aim of this study was to analyze the concentrations of serum cystatin C in neonates with sepsis. Thirty-two neonates (gestational age from 34 to 40 weeks) admitted to the NICU during the first 14 days of life were enrolled. Serum cystatin C concentrations were estimated by ELISA during three successive days in neonates treated for infection. The study group consisted of 9 newborns with sepsis, 14 with severe sepsis and 9 with septic shock. At the beginning of the observational period the mean serum concentration of cystatin C in the study group was 1.35 mg/L (95% CI 1.20-1.49). Surprisingly, the lowest concentration of cystatin was observed in patients with septic shock (1.23 mg/L; 95%CI 0.92-1.54) within the observation period. Higher conce...
Pheochromocytoma occurs with a frequency estimated at 2-7 per 100 000 pregnant women. Unrecognize... more Pheochromocytoma occurs with a frequency estimated at 2-7 per 100 000 pregnant women. Unrecognized, and thus untreated pheochromocytoma is associated with very high (40-50%) maternal and fetal mortality. Pheochromocytoma occurs sporadically or as a family trait. Its presence should be suspected in women with paroxysmal or established hypertension, especially before the 20th week of pregnancy, accompanied by headaches and palpitations, and excessive sweating, muscle tremors, vomiting, anxiety, vasomotor disturbances and blurred vision. The variety of clinical presentations and rarity are the cause of not including the disease in differential diagnosis of hypertension in pregnancy. Biochemical tests are essential in the diagnosis of pheochromocytoma, and involving the assessment of methoxycatecholamine urinary excretion. The second step in the diagnostics is magnetic resonance imaging of adrenal glands. Adrenalectomy is the treatment of choice for pheochromocytoma with adrenal locatio...
Ginekologia polska, 2011
Together with the prolongation and improving the quality of life of young women with chronic rena... more Together with the prolongation and improving the quality of life of young women with chronic renal failure (CRF), procreation becomes an important issue. Pregnancies in women on renal replacement therapy are associated with an increased risk of health complications, both for mothers and for fetuses. Medical management of pregnant women with CRF is a great challenge and requires a close co-operation of nephrologists, transplantologists, gynecologists and neonatologists. The complexity of problems in these particular pregnancies has urged us to describe the case of a woman with CRF who successfully delivered two babies. We also review the current state of knowledge on the topic. The first pregnancy five years after renal transplantation, was completed with the delivery of term newborn with Tetralogy of Fallot. Also the second pregnancy on hemodialysis therapy was finished by the birth of a healthy neonate at term. The described case indicates that the gynecologists should be prepared ...