Cerebral oximetry as method of diagnostics of perinatal brain pathology in newborns with intrauterine growth retardation
The noninvasive monitoring by near-infrared spectroscopy (NIRS) is the perspective method for early diagnostics of the perinatal brain disorders.
Aim. We have studied cerebral oximetry values during the sleep-wake cycle in full-term newborns with intrauterine growth retardation (IUGR).
Material and methods. 15 newborns with IUGR were included in the research group, and 38 newborns in the control group. Cerebral oximetry (CrS02) was measured by NIRS (Somanetic INVOS 5100C, USA) from the left frontoparietal region and was recorded simultaneously by the polysomnography. The fraction of the tissue oxygen extraction (FTOE) was calculated by using SaO2 (pulse oximeter Radical “Masimo”) and CrS02. It was analyzed for 15 minutes by polysomnography-defined: quiet, active sleep, and wake.
Results and discussion. Cerebral oxygen saturation in newborns with IUGR were significantly higher during sleep and wake. Nevertheless, FTOE was considerably lower in the research group than in the control group. The number of erythrocytes with an optimal activity in the research group was 42.8±2.3% versus 60.1±1.2% in control newborns (p<0.05). The low oxygen consumption during the active phase of the first cycle of the sleeping (REM) sleep and wake is indicators of the perinatal defeat of brain functional development.
Conclusion. The usage of NIRS will be a new method for the diagnostic and prognosis of the perinatal pathology of the brain.
Dynamics of prostacycline concentration in urine of patent ductus arteriosus in preterm infants
The aim of our research is an analysis of the concentration of prostacyclin in the urine of preterm infants. Our goal was the identification of additional criteria for diagnosing the patent ductus arteriosus (PDA).
Material and methods. Eighty-two preterm infants with extremely low and very low birth weight delivered before 32 weeks of gestation were examined. Newborns were divided into two groups depending on the presence of PDA. The research group consisted of 22 newborns with PDA. Sixty newborns without PDA were included in the control group. Newborns in both groups underwent a cardiac ultrasound on 2-3 days of life. The level of prostacyclin in the urine on 4-5 days and 28 days was examined. Prostacyclin in the urine was determined by enzyme-linked immunosorbent assay (ELISA).
Results and discussion. The concentration of prostacyclin in the urine of children in the research group for 4-5 days was significantly higher than in newborns in the control group (1335.1 vs 1201.35 pg/ ml; p=0.02). The PDA has diagnosed with a rate of 73.5% with the prostacyclin's concentration in the urine of more than 1278.4 pg/ml at the same age. On 28 days of life, babies from the control group revealed a significant decrease in the concentration of prostacyclin in the urine compared with newborns in the research group (484,9 vs 1201,35 pg/ml, respectively; p=0.003).
Conclusion. The level of prostacyclin and dynamics of it in the first month of life are good predictors of the PDA in preterm newborns delivered before 32 weeks of gestation.
Homeostasis of minerals and trace elements in newborns. Part 2. Clinical role of magnesium balance in the body of newborn
This review clarifies the distribution of magnesium in the body of newborns and infants, elucidates the main variants and clinical manifestations of magnesium imbalance in the newborn's body, describes the factors affecting magnesium homeostasis, particularly the metabolism and pharmacokinetics of magnesium, in newborns at different gestational ages; the methods of diagnosis, treatment and prevention of imbalances in magnesium homeostasis are considered. In the modern scientific literature information on this issue is scarce and often inconsistent. The review contains information available in open literature sources on the use of magnesium preparations and the clinical role of its different concentrations during pregnancy and childhood, methods of detection of magnesium imbalance, immediate and long-term consequences of hypo- and hypermagnesemia in infants. The practical importance of scientific data about the balance of magnesium in the newborn's body, methods of diagnosis and modes of treatment of the detected disorders are highlighted.
Ultrasound lung examination in preterm infants
Preterm newborns remain the most crucial category of NICU patients. Respiratory disorders are one of the leading causes of neonatal morbidity and mortality among premature children. Chest radiography (X-ray) is the routine method to diagnose lung damage associated with the exposure of radiation. Ultrasound (US) lung examination is widespread and an alternative to the X-ray method. Moreover, the US lung scan has additional diagnostic advantages. The article presents the authors' own experience in the US lung examination in preterm infants with different diseases. The importance of the method was described in detail with the focus on the quality of medical care and the safeness of the procedure.
The experience of using the atenolol at newborns with tetralogy of Fallot
We performed the analysis of an experience of the beta-blocker Atenolol for newborns in the tetralogy of Fallot and right ventricle hypertrophy. We observed five newborns with tetralogy of Fallot when Atenolol was started in the dose of 0.5-1.5 mg/kg/day. The congenital heart disease was diagnosed prenatally, and clinical manifestations as episodes of desaturation and cyanosis were presented.
Results. The hypertrophy of the right ventricle and desaturation episodes have significantly decreased in the therapy of Atenolol. Nevertheless, we have not seen the efficacy of the medication in one case.
Conclusion. We presented the possibility and safeness of the beta-blocker Atenolol in newborns with tetralogy of Fallot and severe hypertrophy of the right ventricle. There were not observed any side effects of the therapy of Atenolol.
The role of ultrasound in the early diagnosis of perinatal ischemic strokes. The possibility of duplex scanning in determination of the affected vascular region
Ultrasound methods play an essential role in the early diagnostics of perinatal ischemic strokes, help to identify ischemic foci of the different localization, sizes, and blood flow in the affected vascular pool.
The analysis of ultrasound and clinical data indicates that antenatal and postnatal ischemic stroke have significant differences. Antenatal strokes develop before the delivery is usually localized in the pool of lenticularstriar arteries, and not accompanied by focal neurological symptoms.
Postnatal strokes will happen mostly on the 2nd-3rd day of life and manifested by focal neurological symptoms. They localized in the cortical-subcortical region. Foci of ischemia more visible by ultrasound only at the end of the second day of the disease. Local blood flow disorders in the affected vascular pool detected by duplex scanning from the first day of the disease.
Organization of internal quality and safety control of medical activities: new rules
The article analyzes the novelties of legislation regulating internal control of quality and safety of medical activities, assesses the consequences of non-compliance with mandatory requirements established by law, and determines the algorithm for organizing the system of internal control of quality and safety of medical activities.
Neonatal encephalopathy: need for recognition of multiple etiologies for optimal management
Neonatal encephalopathy (NE) is associated with high mortality and morbidity. Factors predisposing to NE can be antenatal, perinatal, or a combination of both.
Antenatal maternal factors, familial factors, genetic predisposition, hypoxic ischemic encephalopathy, infections, placental abnormalities, thrombophilia, coagulation defects, and metabolic disorders all have been implicated in the pathogenesis of NE. At present, therapeutic hypothermia is the only treatment available, regardless of etiology. Recognizing the etiology of NE involved can also guide investigations such as metabolic and sepsis workups to ensure optimal management. Understanding the etiology of NE may allow the development of targeted adjunctive therapies related to the underlying mechanism and develop preventative strategies.
Culture-negative early-onset neonatal sepsis: at the crossroad between efficient sepsis care and antimicrobial stewardship
Sepsis is a Leading cause of mortality and morbidity in neonates. Presenting clinical symptoms are unspecific. Sensitivity and positive predictive value of biomarkers at onset of symptoms are suboptimal. Clinical suspicion therefore frequently leads to empirical antibiotic therapy in uninfected infants. The incidence of culture confirmed early-onset sepsis is rather low, around 0.4-0.8/1000 term infants in high-income countries. 6 to 16 times more infants receive therapy for culture-negative sepsis in the absence of a positive blood culture. Thus, culture-negative sepsis contributes to high antibiotic consumption in neonatal units. Antibiotics may be life-saving for the few infants who are truly infected.
However, overuse of broad-spectrum antibiotics increases colonization with antibiotic resistant bacteria. Antibiotic therapy also induces perturbations of the non-resilient early life microbiota with potentially long lasting negative impact on the individual's own health. Currently there is no uniform consensus definition for neonatal sepsis. This leads to variations in management. Two factors may reduce the number of culture-negative sepsis cases. First, obtaining adequate blood cultures (0.5-1 mL) at symptom onset is mandatory. Unless there is a strong clinical or biochemical indication to prolong antibiotics physician need to trust the culture results and to stop antibiotics for suspected sepsis within 36-48 h. Secondly, an international robust and pragmatic neonatal sepsis definition is urgently needed. Neonatal sepsis is a dynamic condition. Rigorous evaluation of clinical symptoms (organ dysfunction) over 36-48 h in combination with appropriately selected biomarkers (dysregulated host response) may be used to support or refute a sepsis diagnosis.