Minimal facial movements of the fetus as one of the diagnostic criteria intrauterine distress
The use of the facial movements' evaluation of the fetus as an additional criterion for the detection of the possible fetal distress development is one of the promising trends in modern neonatology, since fetuses from 20-22 to 28 weeks of gestation are a vulnerable group for the development of distress conditions due to the impossibility of using cardiotocography among them.
The aim of the study is to assess the conditions of distress in fetuses in the period from 22-24 weeks of gestation using a standardized set of facial expressions of newborn children in ultrasound diagnostics in 3D and 4D resolution.
Material and methods. The study included 313 fetuses in the gestation period of at least 22-24 weeks, which were consulted and ultrasound-diagnosed in Voronezh Regional Clinical Hospital No.1 "Perinatal Center" in the period of 2017-2019. All the fetuses were divided into 2 groups: the 1st group - fetuses with diagnosed cases of distress in obstetric history (n=98), and the 2nd group - fetuses with no clinical signs of distress (n=215). The main criteria for the inclusion of fetuses in the 1st group of the study were the presence of one or more signs: tachycardia/bradycardia; persistent monotonous of rhythm (recording of 5 bpm or less); early, variable and late deceleration with amplitude of more than 30 beats/min. All fetuses with clinical signs of distress mentioned above were examined immediately after CTG by GE Healthcare Voluson 730.
Results and discussions. During the study, special attention was given to the consistent sets of facial movements of the fetus, where important diagnostic (and subsequent predictive feature) traits were lowering eyebrows, raising inner part of the eyebrow, raising outer part of the eyebrow, and converging inner corners of the eyebrows. This sequence at the time of distress was evaluated by us as a fundamental combination of actions on the face of the fetus.
Conclusions. The comparative data obtained show that the "reading of emotions" is promising in the early diagnosis of "fetal distress". Evaluation of the facial movements of the fetus, which allows to detect the fetal distress needs to be examined and popularized further, since it does not include any additional material costs and can be used in a vulnerable group of fetuses (unacceptable CTG method) from 20-22 to 28 weeks of gestation.
Cardiorespiratory status and cerebral oxygenation in neonates with respiratory disorders
Objective - to assess the relationship between the cardiorespiratory status and cerebral oxygenation and to identify physiological determinants of cerebral oxegenation (crSO2) in newborns with respiratory disorders.
Material and methods. 74 newborns with respiratory disorders were included (36 late preterm and 38 full-term) in observational cohort study. Recording of crSO2 using the INVOS 5100C tissue oximeter (Covidien, Medtronic, USA) was done along standard vital signs monitoring. Patients were assigned to three groups according the hemodynamic support: 1st - infants treated by the combination of dopamine (dose ≥10 pg/kg min) and vasopressor (adrenaline or norepinephrine in a dose of ≥0.05 pg/kg min), 2nd group received dopamine in dose of ≥10 pg/kg min and 3rd - dopamine in dose less than 10 pg/kg min. Cardiorespiratory determinants of crSO2 were found in a multiple linear regression.
Results. crSO2 was lowest in the 1st group - 77 (67; 85)% vs 87 (79; 92)% in 2nd and 81 (76; 87)% in 3rd groups, p=0.0066. Cerebral fractional oxygen extraction (cFTOE) was highest in 1st group 0.21 (0.12; 0.32) vs 0.12 (0.05; 0.23) and 0.16 (0.10; 0.23) in 2nd and 3rd respectively, p=0.0251. Multiple regression revealed significant positive correlation between crSO2 and pCO2 (p=0.0027), cFTOE and Lactate (p=0.0186) and negative between crSO2, MAP (p=0.0479) and Lactate (p=0.0091); as well as cFTOE and pCO2 (p=0.0006). The level of crSO2 ≤66% in newborns on mechanical ventilation and dopamine + vasopressor may indicate hypocapnia (pCO2 <35 mm Hg) with 40% sensitivity and 100% specificity (AUC=0.670, p=0.0343).
Conclusion. Patients with the most compromised cardiorespiratory status had lower levels of crSO2 and higher levels of cFTOE because of hypocapnia and mechanical ventilation with relatively high MAP combined with tissue hypoperfusion.
Pulmonary hypertension associated with bronchopulmonary dysplasia. Review
Bronchopulmonary dysplasia (BPD) is a multifactorial chronic disease highly raised during the last two decades. It mostly affected newborns with extremely or very low birth weight. BPD rate crucially increased up to 68% among premature who were born earlier than 29 weeks of gestational age. Lung hypertension is one of the severe complications with a high proportion of disability and mortality in the late stage of diagnostics. Our review discussed modern risk factors, distribution, pathogenesis, and criteria of the diagnoses of lung hypertension in BPD. Prematurity and duration of mechanical ventilation are not the main risk factors. Those, one from two newborns with necrotizing enterocolitis, could lead to the stenosis of the lung veins and lung hypertension. There is no optimal strategy for the diagnostics and time of the screening in the group of premature newborns with BPD. The leading goal in the treatment of lung hypertension is recovering of pulmonary insufficiency. The second purpose is a decrease of hypoxic/hypercapnic vasoconstriction and the improvement of the intrapulmonary gas exchange. Recently, we do not know universal treating tools for lung hypertension in BPD that give us the chance to perform new research.
Infant, born by cesarean section: possible health risks and opportunities to mitigate them
The article comprises some of modern scientific literature review, dedicated to potential health risks for infants, born by cesarean section without medical indications. Possible mechanisms of such risks are discussed along with strategies to mitigate them - with a focus on the importance of optimal nutrition from birth.
The role of vitamins and trace elements in newborns parenteral nutrition
Vitamins and trace elements are an important component for the growth and development of the fetus during the intrauterine development as well as in newborns during of breastfeeding period. In the case when the enteral nutrition is not possible or limited, it is necessary to prescribe the parenteral form of these components.
This literature review presents an analysis of materials on the quantitative and qualitative component of the parenteral nutrition of newborns - vitamins and trace elements.
Frequency of perinatal asphyxia and volume of provision of care to newborns in the delivery room
Perinatal asphyxia is one of the Leading causes of neurological morbidity and mortality in newborns. There are no accurate statistics in Russia on the frequency and structure of newborns delivered in severe and moderate asphyxia, and resuscitation activity.
The purpose of the study is to analyze the frequency of asphyxia at birth and the resuscitation activity in the delivery room in the Obstetric Clinic III b level in 2017-2018 years and to identify the factors affecting its reduction.
Material and methods. We analyzed 817 cases of birth with asphyxia retrospectively. The assessment of the frequency of routine support, mask and bag ventilation, intubation of trachea for mechanical ventilation, the continuous positive airway pressure, the sustained inflations maneuver, supplement oxygen therapy, heart compression and drugs administrations were made.
Results. In 2017-2018,5749 newborns were delivered on Ivanovo Research Institute of Motherhood and Childhood V.N. Gorodkov, Ministry of Health of Russia. Some of them were bornt prematurely - 1203 (20.9%). The frequency rate of the asphyxia in all newborns was 14.2%, but 2.69% for the full-term infants. Intubation and mechanical ventilation were performed in 21 (0.46%) full-term and 67 (5.6%) preterm infants. Heart compression and drug administration in the group of full-term newborns were not required. Heart compression and drug administration were performed in two cases of premature delivery (0.17%) in the delivery room. We used supplemental room air to reach targeted saturation for the majority of newborns - 656 babies (80.29%).
Conclusion. We have founded the low-frequency rate of newborns with perinatal asphyxia in the Obstetrics Clinic IIIb level. The usage of routine clinical recommendations in practice, rational management, permanent training of the medical officers will decrease the aggression during primary resuscitation of the newborn.
Legal basis for registration of a live birth, viability and the right to life. Part 1
The article describes and evaluates the norms of Russian Legislation related to registration of Live births and stillbirths, taking into account the criteria established in the Legislation of the Russian Federation, international birth criteria defined by the world health organization, prospects for the Legal definition of viability boundaries and criteria for their assessment.
Beractant and poractant alfa in premature neonates with respiratory distress syndrome: a systematic review of real-world evidence studies and randomized controlled trials
Findings from previous meta-analyses of randomized clinical trials (RCTs) in premature infants with respiratory distress syndrome (RDS) varied as to whether clinical outcomes differed by type of animal-derived pulmonary surfactant; real-world evidence (RWE) was excluded. We extracted study characteristics and outcomes from full-text articles from a systematic search for studies that compared beractant with poractant alfa for RDS in preterm infants. RWE data were tabulated; RCT data were subjected to meta-analyses. Designs, patient characteristics, and follow-up durations varied widely among studies (4 RWE, 15 RCT). RWE studies with adjusted odds ratios (ORs) found no statistically significant between-treatment differences in outcomes. In RCT meta-analyses, no statistically significant between-treatment differences were observed for death [OR (95% confidence interval) 1.35 (0.98-1.86)], bronchopulmonary dysplasia [1.25 (0.96-1.62)], pneumothorax [1.21 (0.72-2.05)], and air leak syndrome [2.28 (0.82-6.39)]. Collectively, outcomes were similar with beractant and poractant alfa in RWE studies and pooled RCTs.
Antifungal drugs for invasive Candida infections (ICI) in neonates: future perspectives
Fungal infections may complicate the neonatal clinical course, and the spectrum of therapies for their treatment in the perinatal period is limited. Polyenes, Azoles and Echinocandins represent the three classes of antifungal drugs commonly used in the neonatal period. The present review provides an overview about the most recent therapeutic strategies for the treatment of fungal infections in neonates.