Health care-associated infections in critically ill premature newborns: epidemiology, clinical features and diagnostics in modern conditions
The aim of this study was to investigate the interrelation between clinical manifestations, laboratory signs of a systemic inflammatory reaction, and features of colonization of the mucous membranes by opportunistic microorganisms in premature infants of various gestational age in cases of health care-associated infections.
Material and methods. During the prospective study 50 premature neonates older than 72 hours of age, received medical treatment in NICU from January 2017 to December 2018 were examined. In such a case of health care-associated infection clinical manifestations, laboratory signs of a systemic inflammatory reaction and features of mucosal colonization were studied.
The results. It was found that both the highest incidence of hospital-acquired infection (HAI) and the maximum of number and frequency laboratory changes (markers of a systemic inflammatory reaction) were noted in neonates of GA ≤28 weeks. They were recorded at the earliest and were prognostically significant markers in all groups of newborns: an increase in the level of procalcitonin and neutrophilia, which were observed on average in half of cases of infections associated with medical care.
In preterm neonates GA >32 weeks, changes in the number of laboratory changes (markers of systemic inflammatory response) were less pronounced. The frequency of an isolated elevation of one of the markers was increasing with gestational age. Among the representatives of opportunistic microorganisms isolated from the pharynx and anus, gram-positive coagulase-negative staphylococci prevailed in preterm infants of any gestational age, most often Staphylococcus epidermidis. Gram-negative flora was represented by various species of the Enterobacteriaceae family with a predominance of Klebsiella pneumoniae in all groups of children.
Identification of fungal microflora was observed only in very premature neonates. In all cases, it was represented by fungi of the species Malassezia furfur. The species diversity of microorganisms at the moment of HAI onset was higher in very premature infants compared to neonates born after 32 weeks, which may indicate a long hospitalization of patients of these groups in the NICU.
Assessment of the health of children born with the help of assisted reproductive technologies, according to the data of regional information medical systems
The aim of the study is to assess the health of children conceived using assisted reproductive technologies (ART).
Material and methods. Children of the main (n=896, conceived using ART) and control groups (n=896 children, conceived naturally), aged 1-3 months, 6 months, 1 year, 1 year 6 months, 2 years, 2 years 6 months, 3 years. Methods: descriptive statistics, nonparametric Z-criterion for the share, with a reliable significance level of p-value <0.05.
Results. Children of the main group, versus with children of the control group, have unspecified encephalopathy (p=0.0396), neonatal jaundice associated with premature delivery (p=0.0180), gastroesophageal reflux without esophagitis (p=0.0002), comparing of the ICD-10 rubrics.
Conclusion. Children who was born using ART need a multidisciplinary approach in early care, development of individual rehabilitation and habilitation programs, and implementation of nutritional rehabilitation interventions.
The relationship of the level of bilirubin determined by the non-invasive portable automatic analyzer «Bilitest AGF-02» and the total bilirubin concentration in blood serum determined by the standard biochemical method in full-term newborns and late premature infants
Due to early discharge of newborns from maternity homes, it is necessary to settle the issue of improving the quality of predicting threatening hyperbilirubinemia. The use of devices for bedside non-invasive measurement of bilirubin concentration in the skin can help to solve the problem and determine the tactics of management of newborns with threatening hyperbilirubinemia.
The article describes a prospective examination of 810 newborns, conducted by the use of a device of domestic production "Bilitest". The results report that a moderate correlation of transcutaneous bilirubin index indicators of the "Bilitest" device with the concentration of bilirubin in the blood serum for transcutaneous bilirubin index below 260 was found. It calls into a question the predictive value of measuring transcutaneous bilirubin index done by this device.
Orofaringeal introduction of colostrine - survey data and theoretical prospects
The aim of the study - to identify the frequency of practical use, the variety of methods for early oropharyngeal administration of colostrum (EOAC) among neonatologists and resuscitators in cities of the Russian Federation, the awareness of the importance of EOAC for newborn children and mothers.
Material and methods. A survey of 200 doctors was conducted on the developed monitoring map in 18 cities of the Russian Federation. The map is compiled by sections: city of residence, place of work, work experience in neonatology, application of the EOAC method with the response option «yes, no». If the answer is positive, the details of the technology were evaluated, namely the capacity used, the time of the first colostrum administration, the volume of colostrum injected, and the specific method.
Results. The frequency of using EOAC in premature and sick newborns in maternity ward among the doctors surveyed was 86%. A variety of methods have been identified. Most doctors express colostrum in a syringe, in a beaker, other vessels and inject directly into the newborn's oral cavity. Some doctors place colostrum on a cotton pad behind the cheek of a child or lubricate the baby's lips so, that the colostrum enters the oral cavity. The preferred method is expressing into a syringe. On average, a child receives up to 0.5 ml of colostrum.
Conclusions. The survey data indicate a high frequency of use of early oropharyngeal administration of colostrum to premature and sick newborns in cities of the Russian Federation. This reflects sufficient knowledge, understanding by doctors - neonatologists and resuscitators of the importance of administering colostrum to newborns, starting immediately after birth in the maternity ward when their condition is stabilized. The lack of a single optimal method requires the standardization of EOAC.
Radiodiagnosis in bronchopulmonary dysplasia: projection radiograph of the chest
For the first time ever, bronchopulmonary dysplasia (BPD) was described in 1967 based on the correlation of morphological and radiological changes in premature infants who were on artifcial ventilation. Since then, several x-ray criteries have been suggested for the diagnosis of BPD with different informational content and diagnostic consideration. On the basis of literature data and results of our own researchs and clinical cases, this review is presenting x-ray morphological comparisons and criteries in BPD, information about differential diagnosis, as well as the dynamic of x-ray changes in childen as they are aging.
Legal basis for registration of a live birth, viability and the right to life. Part 2
The article describes the legally fixed possibilities of refusal of resuscitation measures, cases of nonresuscitation measures, studies the experience of refusal of resuscitation and the possibility of written confirmation of their will, available in France.
The most common patient safety issues resulting in legal action against neonatologists
Common patient safety issues may result in injuries to babies in the newborn period. A medical malpractice lawsuit is one way in which an injured patient can obtain compensation for the injuries they sustained as the result of an error. There are a number of common areas of malpractice risk for neonatologists including the delivery room, jaundice, hypoglycemia, and late preterm infants. A better understanding of the medical malpractice system and common patient safety issues in neonatology can lead to protective strategies to reduce risk for untoward events and subsequent litigation. Strategies including maintaining competency, following national guidelines, and proper communication and documentation can improve the care and treatment of neonatal patients and their families resulting in less malpractice exposure.
Systematic reviews in neonatal respiratory care: are some conclusions misleading?
An increasing amount of information is currently available in neonatal respiratory care. Systematic reviews are an important tool for clinical decision-making. The challenge is to combine studies that address a specific clinical question and have similar characteristics in terms of populations, interventions, comparators, and outcomes, so that their combined results provide a more precise estimate of the effect that can be validly extrapolated into clinical practice. The concept of heterogeneity is reviewed, emphasizing that it should be considered in a wider perspective and not just as a mere statistical test. A case is made of how well-designed studies of the neonatal respiratory literature, when equivocally combined, can provide very precise but potentially biased results. Systematic reviews in this field and others should be rigorously peer-reviewed before publication to avoid misleading readers to potentially biased conclusions.
Fine tuning non-invasive respiratory support to prevent lung injury in the extremely premature infant
Within the last decades, therapeutic advances, such as antenatal corticosteroids, surfactant replacement, monitored administration of supplemental oxygen, and sophisticated ventilatory support have significantly improved the survival of extremely premature infants. In contrast, the incidence of some neonatal morbidities has not declined. Rates of bronchopulmonary dysplasia (BPD) remain high and have prompted neonatologists to seek effective strategies of non-invasive respiratory support in high risk infants in order to avoid harmful effects associated with invasive mechanical ventilation. There has been a stepwise replacement of invasive mechanical ventilation by early continuous positive airway pressure (CPAP) as the preferred strategy for initial stabilization and for early respiratory support of the premature infant and management of respiratory distress syndrome. However, the vast majority of high risk babies are mechanically ventilated at least once during their NICU stay. Adjunctive therapies aiming at the prevention of CPAP failure and the support of functional residual capacity have been introduced into clinical practice, including alternative techniques of administering surfactant as well as non-invasive ventilation approaches. In contrast, the strategy of applying sustained lung inflations in the delivery room has recently been abandoned due to evidence of higher rates of death within the first 48 h of life.