https://mja.mk/journal/index.php/mja/issue/feed 2026-04-05T19:54:50+00:00 MJA admin macedoniananesthesiology@gmail.com Open Journal Systems <p><strong><a href="https://mja.mk">https://mja.mk</a></strong></p> https://mja.mk/journal/index.php/mja/article/view/59 2026-04-05T19:54:50+00:00 Jasmina Ilievska jasminailievska@gmail.com

Cardiovascular disease (CVD) remains the leading global cause of morbidity and mortality, influenced by a complex interplay of genetic and environmental factors. By many, medicine is entering the era of personalized management approach, in one direction because of the advances in genomics, particularly genome-wide association studies (GWAS). Monogenic disorders such as familial hypercholesterolemia, driven by mutations in LDLR, APOB, and PCSK9, illustrate the profound impact of single-gene defects on lipid metabolism and coronary artery disease (CAD) risk. In contrast, polygenic risk scores aggregate multiple variants to refine individual risk prediction for multifactorial diseases such as CAD, though their predictive utility remains modest when added to conventional clinical models. Beyond protein-coding genes, non-coding RNAs (miRNAs, lncRNAs) and endothelial nitric oxide synthase (eNOS) polymorphisms have emerged as key regulators of vascular function and inflammation, offering novel insights into disease mechanisms. However, the clinical translation of genetic testing is hindered by limited predictive accuracy, ethnic bias in genomic research, and challenges in interpreting variants of uncertain significance. Ethical considerations, including psychological impact and data privacy, further complicate its application. Future directions emphasize integrating multi-omics data, diversifying genetic studies, and advancing gene-based therapies such as CRISPR-mediated PCSK9 editing and RNA silencing approaches. Ultimately, while genetic testing holds promise for precision medicine in cardiovascular care, its implementation must be accompanied by improved risk modeling, equitable population representation, and rigorous clinical validation.

2026-04-05T00:00:00+00:00 Copyright (c) 2025 https://mja.mk/journal/index.php/mja/article/view/50 2026-04-05T19:07:10+00:00 Rexhep Sopaj Etemi rexha78@yahoo.com

Introduction: Total gastrectomy remains the gold standard for gastric adenocarcinoma treatment. The procedure poses significant anesthetic challenges due to its complexity and the physiological stress associated with major abdominal surgery. These challenges are further amplified in patients with a history of other diseases, especially those affecting the cardiovascular system, who require careful hemodynamic management and tailored perioperative strategies in the operating room. Case Presentation: This case report presents the perioperative management of a 62-year-old male diagnosed with gastric adenocarcinoma who underwent total gastrectomy. The patient had undergone surgical repair of an ascending aortic dissection three years earlier. Preoperative transthoracic echocardiography was obtained to assess cardiac function and graft integrity. Anesthetic induction was performed with carefully titrated agents to maintain hemodynamic stability. Invasive arterial blood pressure monitoring was employed throughout the procedure to allow real-time hemodynamic management. Analgesia was provided via a thoracic epidural catheter, with a continuous infusion of low-concentration bupivacaine (0.125%) administered to minimize sympathetic blockade and maintain stable blood pressure. The patient reported minimal discomfort and did not require additional analgesics during the recovery period. He was discharged in good general condition on postoperative day eight. Conclusion: Patients with prior ascending aortic dissection repair undergoing major abdominal surgery pose significant anesthetic challenges. With appropriate monitoring and individualized management, good outcomes can be achieved.

2026-04-05T00:00:00+00:00 Copyright (c) 2025 https://mja.mk/journal/index.php/mja/article/view/51 2026-04-05T19:15:24+00:00 Mirjana Krmzova Gjorgjioska 496mirjana@gmail.com

Background: Anesthetic management of pediatric patients for corrective cardiac surgery is highly complex when portal hypertension, severe thrombocytopenia and inherited thrombophilia coexist. The interplay between bleeding and thrombotic risks requires meticulous planning. Case report: We present the case of a 5-year-old child with congenital heart disease and severe thrombocytopenia who was scheduled for corrective cardiac surgery. The child was hospitalized for the first time 6 months earlier because of a sudden abdominal pain and hematemesis, leading to the diagnosis of portal hypertension and inherited thrombophilia. At the time he presented for surgery, the child had very low platelets, 36x10^9/L with no other abnormalities in the laboratory results. Anesthetic management focused on balancing hemorrhage and thrombosis, optimizing coagulation with viscoelastic testing, goal-directed transfusion therapy and maintaining stable hemodynamics. Surgery was completed successfully, with close postoperative monitoring in the pediatric cardiac ICU. Conclusion: This case highlights the challenges of managing a child with combined bleeding and thrombotic risks. Individualized anesthetic strategies and multidisciplinary approach are essential to achieve safe outcomes in such high-risk background.

2026-04-05T00:00:00+00:00 Copyright (c) 2025 https://mja.mk/journal/index.php/mja/article/view/52 2026-04-05T19:21:23+00:00 Sanja Kolevska kolevskasanja@yahoo.com

Cerebral palsy (CP) is a group of non-progressive neurological disorders affecting posture and movement, mostly resulting from perinatal intrauterine disorders to the developing infant brain. A 6-years old, male patient with spastic cerebral palsy (CP), which predominantly affected the right extremities more than the left ones, required dental surgical treatment of multiple tooth extractions and restorations, under general anesthesia. He received allogenic umbilical cord derived mesenchymal stem cells treatment one time, 6 months before the dental intervention. The intervention under general anesthesia lasted approximately one hour and concluded successfully. Muscle relaxants were purposely avoided. The anesthesia was reversed and the patient was extubated successfully without complications and there was no sign of any adverse reactions postoperatively.

2026-04-05T00:00:00+00:00 Copyright (c) 2025 https://mja.mk/journal/index.php/mja/article/view/53 2026-04-05T19:26:22+00:00 Angela Trposka Poposka trposkaa@hotmail.com

Background: Carotid body tumors (paragangliomas) are uncommon neuroectodermal neoplasms, constituting roughly 1–2% of all head and neck cancers. Their proximity to the carotid vessels and cranial nerves presents considerable perioperative anesthetic problems, especially regarding the danger of hemodynamic instability during tumor manipulation. Case presentation: We detail the perioperative anesthetic care of a 68-year-old female with a left-sided carotid body tumor, who experienced flushes, palpitations, and headaches. Preoperative imaging confirmed the diagnosis, while the preoperative assessment identified a potentially difficult airway and the need for invasive monitoring. General anesthesia was administered with invasive arterial and central venous monitoring. During tumor dissection, the patient experienced recurring bouts of vagally mediated bradycardia, which resolved upon cessation of manipulation and the administration of atropine and low-dose adrenaline infusion. Hemodynamic stability and sufficient cerebral perfusion were preserved during the surgery. The postoperative recovery was unremarkable, and the patient was discharged on the third day after surgery. In conclusion: Meticulous hemodynamic monitoring, prompt intervention for vagal reactions, and thorough multidisciplinary collaboration are crucial for the safe administration of anesthesia during carotid body tumor removal.

2026-04-05T00:00:00+00:00 Copyright (c) 2025 https://mja.mk/journal/index.php/mja/article/view/54 2026-04-05T19:30:51+00:00 Vlatko Lukarov vlukarov@gmail.com

Invasive breast carcinoma is the most common malignant breast tumor and remains a major global public health challenge, with high morbidity and mortality rates among women worldwide. Early diagnosis relies on clinical assessment, imaging, and histopathological evaluation, while treatment requires a multidisciplinary approach. Invasive ductal carcinoma (IDC) accounts for approximately 70–80% of invasive cases, most frequently metastasizing to regional lymph nodes and distant organs via lymphatic and hematogenous pathways. We present a case of a 78-year-old female with a palpable retro areolar mass in the right breast, accompanied by nipple retraction, erythema, and peau d’orange appearance. Imaging, including mammography, CT, and ultrasound, demonstrated an irregular, multilobulated, hypoechoic lesion consistent with malignancy, while fine-needle aspiration biopsy confirmed invasive ductal carcinoma. Immunohistochemistry revealed strong estrogen receptor positivity (ER 90%) and weak progesterone receptor expression (PR 2%), suggesting a hormonally driven tumor subtype with therapeutic implications. This case highlights the diagnostic value of multimodal imaging and histopathology in elderly patients, where delayed presentation, comorbidities, and low socioeconomic status may complicate both the diagnostic process and access to timely treatment. It underscores the importance of early detection, sustained clinical suspicion, and a coordinated multidisciplinary approach to optimize outcomes in invasive breast carcinoma.

2026-04-05T00:00:00+00:00 Copyright (c) 2025 https://mja.mk/journal/index.php/mja/article/view/55 2026-04-05T19:35:58+00:00 Gordana Bozinovska-Beaka g.bozinovska.beaka@gmail.com

Transvaginal intestinal evisceration is an exceptionally rare and insufficiently documented complication of vaginal hysterectomy, requiring rapid recognition and surgical management to avoid serious outcomes such as bowel ischemia, perforation, and sepsis. We report the case of a 70-year-old woman who had undergone vaginal hysterectomy fourteen months before she presented with acute abdominal pain accompanied by a substantial segment of small bowel protruding through a defect in the vaginal vault. She was immediately taken to the operating room, where the abdominal cavity was opened and the bowel was manually reinserted into the abdominal cavity, and the vaginal defect was closed with a medical stapler. Several surgical strategies—including laparoscopic, abdominal, transvaginal, and combined approaches—have been described, each demonstrating comparable results. Consequently, the choice of technique should be individualized based on the patient’s clinical condition.

2026-04-05T00:00:00+00:00 Copyright (c) 2025 https://mja.mk/journal/index.php/mja/article/view/56 2026-04-05T19:42:04+00:00 Mite Zdravev mite.zdravev@gmail.com

We present the case of a 58-year-old female with mesenteroaxial gastric volvulus secondary to a large paraesophageal hernia. The patient underwent successful surgical treatment via median laparotomy, including adhesiolysis, gastric detorsion, cruroplasty, and Nissen fundoplication. Her postoperative recovery was uneventful. This case highlights the importance of early recognition, cross-sectional imaging, and timely surgical intervention in preventing morbidity and mortality associated with gastric volvulus.

2026-04-05T00:00:00+00:00 Copyright (c) 2025 https://mja.mk/journal/index.php/mja/article/view/57 2026-04-05T19:46:06+00:00 Natasha Nikchevska natasanikcevska@gmail.com

Introduction: Aldosterone synthase deficiency (ASD) is a rare autosomal recessive disorder caused by pathogenic variants in the CYP11B2 gene, leading to impaired aldosterone synthesis and life-threatening salt-wasting. We present a case of an infant with failure to thrive, dehydration, and electrolyte imbalance, diagnosed through next-generation sequencing. Material and Methods: A 9-month-old male infant was admitted with persistent vomiting, constipation, and a10% weight loss. Laboratory evaluation showed severe hyponatremia (116 mmol/L), hyperkalemia (6.5 mmol/L), hypochloremia (87 mmol/L), and metabolic alkalosis. Differential diagnosis included gastrointestinal loss, renal salt-wasting, cystic fibrosis, celiac disease, and congenital adrenal hyperplasia. Normal 17-hydroxyprogesterone excluded classical CAH. Next-generation sequencing was performed. Results: A homozygous pathogenic variant c.554C>T (p.Thr185Ile) in CYP11B2 confirmed ASD. Treatment with fludrocortisone and sodium supplementation resulted in rapid correction of electrolytes and improved growth. Follow-up at 3.5 years showed normal growth (14.5 kg, 103 cm), stable electrolytes, and normal development, with only mild transient hyponatremia during illness. Conclusion: ASD should be considered in infants with vomiting, dehydration, and combined hyponatremia–hyperkalemia when CAH is excluded. Early diagnosis and mineralocorticoid therapy prevent complications and support normal development.

2026-04-05T00:00:00+00:00 Copyright (c) 2025 https://mja.mk/journal/index.php/mja/article/view/58 2026-04-05T19:50:46+00:00 Marjan Boshev marjanboshev@gmail.co

Introduction: Coronary artery disease (CAD) is typically a chronic, progressive, inflammatory disease of the coronary arteries caused by coronary atherosclerosis. Moderate-to-severe calcification is present in up to 30% of patients undergoing coronary angiography (CA). Calcified coronary artery lesions are one of the most complex and challenging lesion subsets in interventional cardiology. Shockwave intravascular lithotripsy (IVL) is a recently introduced calcium-modifying technique for the treatment of concentric, eccentric and nodular calcifications. Case presentation: We present a clinical case of a 73-year-old male complaining of intermittent chest pain. He was a non-smoker with a positive familiar history for CVD. He had previous myocardial infarction and stenting of the right coronary artery (RCA), previous CVI, paroxysmal atrial fibrillation, insulin-dependent type 2 diabetes, heart failure with mildly reduced ejection fraction (HFmrEF) and chronic kidney disease (CKD) stage II/IIIa. CA revealed heavily calcified CAD. A calcified lesion of the left anterior descending artery (LAD) was treated using a 3.0/12 mm Shockwave IVL balloon; and calcium cracks and fractures were confirmed by optical coherence tomography (OCT). We proceeded with an NC balloon and finally treated the lesion with a 3.5/15 mm drug-coated balloon (DCB). The calcified lesion of the RCA was treated with conventional techniques using guiding catheter extension, NC balloons and drug-eluting stent (DES). Conclusion: Heavily calcified coronary artery lesions remain one of the biggest challenges for interventional cardiologists. Shockwave IVL is designed for treatment of all types of heavily calcified lesions using acoustic waves (shock waves). IVL is safe and effective technique that will definitely strengthen the armamentarium for modern treatment of heavily calcified lesions.

2026-04-05T00:00:00+00:00 Copyright (c) 2025 https://mja.mk/journal/index.php/mja/article/view/41 2026-04-05T18:12:30+00:00 Nikolina Zdraveska nikolina_389@yahoo.com

Not applicable

2026-04-05T00:00:00+00:00 Copyright (c) 2025 https://mja.mk/journal/index.php/mja/article/view/42 2026-04-05T18:18:28+00:00 Gordana Mirchevska gordmir@gmail.com

Introduction: Invasive aspergillosis is an important cause of mortality in patients with malignant diseases, and is an underestimated infection in critically ill patients. Early diagnosis is still challenging, therefore a rapid and more sensitive diagnostic methods could be beneficial. Aim: the aim of the study was to evaluate the sensitivity and specificity of the galactomannan antigen test in respiratory samples, compared to conventional methods, for early diagnosis of aspergillosis. Material and methods: Samples of 125 patients divided into 4 groups, classified according to diagnosis and EORTC/MSG criteria, were analysed at the Institute of Microbiology and Parasitology, with culture and galactomannan test in respiratory samples, during a period of two years. Results: A total of 71 isolates of Aspergillus were confirmed in this study. Culture of respiratory samples revealed Aspergillus in the group of chronic aspergillosis (63.33%), followed by groups of cystic fibrosis (56.67%), primary immune deficiency (51.43%), and the group with prolonged ICU stay (43.33%). Sensitivity and specificity of respiratory samples’ culture were: 64.29% and 100%, 59.09% and 100%, 54.55% and 12.5%, 100% and 54.17%, in all four groups, respectively. Sensitivity and specificity of galactomannan in respiratory samples, were: 75% and 57.14%, 86.36% and 62.5%, 81.82% and 0%, 50% and 70.83%, in all 4 groups, respectively. Conclusion: The results of this study demonstrate that positive galactomannan test in respiratory samples could be a useful diagnostic adjunct in diagnosis of aspergillosis, along with results from conventional mycological analyses, so timely antifungal treatment is administered.

2026-04-05T00:00:00+00:00 Copyright (c) 2025 https://mja.mk/journal/index.php/mja/article/view/43 2026-04-05T18:21:49+00:00 Kristina Dimitrijevikj kristinamitreska@hotmail.com

Introduction: Sarcoidosis is a systemic inflammatory disease of unknown origin, characterized by the formation of non-caseating granulomas in various organs, most commonly the lungs and lymph nodes. The disease can involve multiple organ systems, leading to a wide range of clinical manifestations. Sarcoidosis is often diagnosed through a combination of clinical presentation, radiological findings, and histopathological evidence of granulomatous inflammation. The aim of the study is to detect HRCT features of pulmonary sarcoidosis and their correlation with cough. Material and Methods: In the past two years, fifty patients diagnosed with sarcoidosis were treated at our University Clinic for Pulmonology and Allergology -Skopje. Computed tomography with high resolution was conducted on 128 slice CT scanner PHILIPS INCISIVE, using 1 mm thin-slice thickness and a special reconstruction algorithm. Results: Cough was present in 80% patients, mostly with low intensity (40%). Micronodular changes (1–3 mm), localized peribronchovascularly in the upper and middle lung zones, were observed significantly less often in patients with cough than in those without cough (10% vs 40%, p=0.041). A statistically significant difference between the cough and no-cough groups was identified in the localization of these changes in the peripheral and subpleural regions (p=0.037). The difference was confirmed between the patients with and without cough in terms of the frequency of hypoattenuation findings in the lower peripheral and subpleural zones. Conclusion: High-resolution computed tomography (HRCT) is the preferred imaging modality for evaluating pathological changes in pulmonary sarcoidosis. It provides detailed visualization of characteristic findings, such as lymphadenopathy, micronodules, and other lesions, along with their distribution patterns and any atypical changes. Despite its utility, further research is needed to better understand the mechanisms underlying cough in patients with sarcoidosis.

2026-04-05T00:00:00+00:00 Copyright (c) 2025 https://mja.mk/journal/index.php/mja/article/view/44 2026-04-05T18:25:52+00:00 Nikola Brzanov nikolabrzanov@gmail.com

Background: Polytrauma remains a leading cause of mortality worldwide. Rapid triage and timely diagnostic evaluation are essential for improving survival outcomes. Computed tomography (CT) remains the gold standard imaging modality, but logistical limitations often delay diagnosis in resource-limited settings. Focused Assessment with Sonography for Trauma (FAST) enables rapid bedside evaluation and early detection of life-threatening injuries. The objective of this study was to evaluate the impact of FAST on triage timing, diagnostic efficiency, and early management of polytrauma patients. Material and methods: This prospective study included 40 patients assessed with FAST upon admission. Evaluated variables included demographics, mechanism of injury, FAST duration, diagnostic timings, intervention times, accuracy, ICU admission, complications, and mortality. FAST was performed at five standard anatomical views by a single trained physician. Statistical analysis included descriptive methods and Wilcoxon testing. Results: Mean FAST duration was 5.12 minutes. FAST did not delay CT imaging nor the total diagnostic process (p >0.05). Accuracy was 92.5% for thoracic trauma and 85% for abdominal trauma. Surgical interventions were required in 42.5% of cases; while the median time to surgery was 2.42 hours. ICU admission was recorded in 55% of patients, and mortality reached 22.5%. Conclusion: FAST significantly optimized early trauma triage without delaying CT or treatment. Its speed, accuracy, and bedside availability make FAST indispensable in emergency trauma care. The method is particularly beneficial in resource-limited environments. FAST should be integrated as a mandatory component of initial trauma protocols.

2026-04-05T00:00:00+00:00 Copyright (c) 2025 https://mja.mk/journal/index.php/mja/article/view/45 2026-04-05T18:31:23+00:00 Kristina Dimitrijevikj kristinamitreska@hotmail.com

Introduction: Sarcoidosis is a multisystemic and often chronic disease that can involve nearly any organ. The lungs and intrathoracic lymph nodes are the most commonly affected structures. The aim: of the study is to classify the stages of sarcoidosis and analyze their correlation with clinical symptoms. Material and Methods: A total of 50 patients with sarcoidosis came to our University Clinic for Pulmonology and Allergology-Skopje during 2022-2023 period - a retrospective observational study. A high-resolution computed tomography (HRCT) using a 128-slice PHILIPS INCISIVE CT scanner was performed to all patients, using a 1 mm thin-slice protocol optimized for thoracic imaging. Disease staging was conducted according to the Scadding Score System. Clinical symptoms such as smoking, dyspnea and cough were identified from the MOJ TERMIN medical records and compared with the stage of the disease. Results: The disease stage did not significantly correlate with the patients’ sex and age, but it did significantly correlate with their place of residence. There was a statistically significant difference in the distribution of former smokers across disease stages, driven by the significantly higher proportion of former smokers in stage III compared to stage II. The disease stage had a significant impact on patient hospitalization. The disease stage had a significant impact on the presence of reticular opacities in the upper and middle zones.

2026-04-05T00:00:00+00:00 Copyright (c) 2025 https://mja.mk/journal/index.php/mja/article/view/46 2026-04-05T18:37:19+00:00 Suzana Arbutina suzana.arbutina@yahoo.com

Background: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition characterized by persistent airflow limitation, chronic inflammation, and represents a significant burden globally. Long-term oxygen therapy (LTOT) improves survival, reduces exacerbations, and enhances health-related quality of life (HRQoL) among patients with severe hypoxemia. However, economic constraints in many health systems restrict access to LTOT, potentially exacerbating symptom burden and the overall functional decline. This study evaluates whether economic inaccessibility to LTOT is associated with differences in symptoms and perceived health status among COPD patients who meet clinical criteria for LTOT. Material and methods: A cross-sectional study was conducted involving 60 adults with COPD who met physiological criteria for LTOT. Participants were divided into two groups: LTOT users (n = 30) and LTOT non-users (n = 30) who could not obtain therapy due to financial limitations. Symptoms and health status were assessed using the COPD Assessment Test (CAT). Statistical analyses included t-tests, Mann–Whitney U tests, chi-square tests, and Cohen’s d. Results: Patients without access to LTOT demonstrated higher CAT scores, indicating worse symptom burden and lower health status. Although the mean difference did not reach statistical significance, the effect size suggested a small-to-moderate clinically meaningful trend favoring LTOT users. A higher proportion of LTOT non-users fell into the very high impact CAT severity band. Conclusion: Economic barriers to LTOT access may contribute to poorer symptom control and diminished quality of life in COPD patients who meet established criteria for oxygen therapy. Addressing financial constraints through policy reforms may improve equity in COPD care and reduce disease burden.

2026-04-05T00:00:00+00:00 Copyright (c) 2025 https://mja.mk/journal/index.php/mja/article/view/47 2026-04-05T18:48:19+00:00 Natasha Stojkovska n.stojkovska@hotmail.com

Introduction: Thyroid nodules are a common finding in clinical practice, with prevalence ranging from 2-6% on physical examination, 19–35% on ultrasound, and 8–65% in autopsy studies. Their incidence increases with age and is more frequent in women, individuals with iodine deficiency, and those previously exposed to ionizing radiation. Hashimoto’s thyroiditis may alter cytological interpretation and affect diagnostic accuracy. Methods: This retrospective study included 80 patients with thyroid nodules and Hashimoto’s thyroiditis who underwent fine-needle aspiration biopsy (FNAB), followed by surgical thyroid resection. Diagnostic accuracy parameters were calculated based on histopathological findings as the reference standard. Results: FNAB demonstrated high sensitivity, indicating effective detection of malignant lesions. The positive predictive value was 100%, confirming the strong reliability of FNAB in identifying malignancy when cytology is positive. However, false-negative results occurred predominantly in Bethesda categories I and II. Conclusion: FNAB remains a key and highly accurate preoperative diagnostic method for evaluating thyroid nodules. The exceptionally high positive predictive value supports its diagnostic strength. Nevertheless, the presence of false-negative cases underscores the need for close clinical and ultrasound follow-up in patients with benign cytology, particularly due to the possibility of microcarcinoma or slow-growing thyroid carcinoma.

2026-04-05T00:00:00+00:00 Copyright (c) 2025 https://mja.mk/journal/index.php/mja/article/view/48 2026-04-05T18:59:00+00:00 Gabriela Bushinoska Ivanova gabcence@yahoo.com

Introduction: Neonatal mortality (NNM) is a mortality in newborns in within the first 28 days after birth. Prematurity and the complications from prematurity are the leading cause for higher NNM rates. A premature newborn is born less than 37 gestational weeks of pregnancy. Low birth weight and low gestational age at delivery and their complications are the leading causes of NNM. Aim of the study: The aim of this paper is to present our results gathered from the material of the newborns treated at the Neonatal Intensive Care Unit (NICU) at the University Clinic of Gynecology and Obstetrics in Skopje (UGOC- Skopje), demonstrating that prematurity and complications of prematurity have been the main causes of increased mortality among newborns, in the analyzed period of 9 months. Material and methods: The study is a cross-sectional prospective research that included 445 newborns who were transferred to the NICU for resuscitation, monitoring and treatment after birth, over a period of 9 months or the period from May 1, 2019 to January 31, 2020, at the University Clinic of Gynecological and Obstetric (UGOC) in Skopje. In this paper, we focused on prematurity and complications of prematurity, which had a significant impact on the NNM of newborns in the NICU, in the analyzed period. Results: The study shows that the leading causes for NNM at UGOC- Skopje were prematurity and complications from prematurity: low gestational age at birth, low birth weight, asphyxia, ARDS, NEC, intracranial hemorrhage, sepsis, congenital anomalies etc. Cesarean delivery, prenatal administration of corticosteroids, higher APGAR score in the 1st and 5th minutes, have a significant impact on the survival of newborns and reduction of mortality in newborns. Conclusion: For a long period of time N. Macedonia was a country with one of the highest NNM rates in Europe. Prevention of prematurity and complications from prematurity, improved health and prenatal service, all this reduce the prematurity and NNM. The reasons for higher NNM are preventable and need programs for health care and education of patients, and better public health service.

2026-04-05T00:00:00+00:00 Copyright (c) 2025