The diagnostic value of the method of oxygen pulse oximetry for the identification of critical congenital heart defects in delivery house. Experience of the Volgograd Region
Results of the implementation of a regional protocol for early screening of the critical congenital heart diseases by pulse oximetry were analyzed retrospectively. We used the oxygen pulse oximetry for the evaluation of asymptomatic congenital heart diseases. The diseases do not screen antenatally and presumed at Neonatal Ward of Maternity Clinic by oxygen pulse oximetry.
Motor and psycho-preverbal development of extremely preterm infants who were suffering in congenital pneumonia and early neonatal sepsis in the first 12 months of corrected age
The information regarding the frequency and severity of Long-term neurological outcomes in preterm infants suffering from congenital pneumonia and early neonatal sepsis was Limited in the international Literature. Therefore, it will be necessary for the further study.
Aim of the study - the assessment of the frequency rate of a motor, psycho-preverbal development and neurological outcomes in preterm infants that were born with extremely low birth weight (ELBW) and very low birth weight (VLBW) and undergoing congenital pneumonia, and early neonatal sepsis, at the age of 3rd, 6th and 12th months of corrected age.
Material and methods. 80 children were included in the study. They were born with VLBW and ELBW and gestational age (GA) up to 32 weeks in V.I. Kulakov Obstetrics, Gynecology and Perinatology National Medical Research Center of Ministry of Healthcare of the Russian Federation. The examination performed at 3rd, 6th, and 12th months of corrected age. Children were divided into 2 groups: 1st group - congenital bacterial infection (n=35): 1A subgroup - early neonatal sepsis (n=13), 1B subgroup - congenital pneumonia (n=22); 2nd group -respiratory distress syndrome (RDS) with the no signs of congenital infection (n=45).
Results and discussion. There were statistic significant (p<0.05) increasing of muscle tone disorders in the structure of perinatal central nervous system lesions in the 1st group of children compared to the 2nd group at the 3rd, 6th and 12th months of corrected age. The examination with Griffiths scale on 3rd months of corrected age did not present statistically significant differences between the groups. Probably, these findings were determined by non-specific indicators of psycho-preverbal development at this age. At 6th and 12th months of corrected age, the children of subgroup 1A had a statistically significant delay in psychomotor development relative to the corrected age. While the development of kids in subgroups 1B and 2 groups were often normal (p<0.05). Porencephaly was detected more frequently on 3rd, 6th, and 12th months of corrected age in children of subgroup 1A (p<0.05) by ultrasound (US). The children of subgroup 1A presented ventriculomegaly, porencephaly, and periventricular gliosis by MRI-study compared with 2nd group (p<0.05). The incidence of cerebral palsy (CP) was 11.25% in all groups of children with VLBW and ELBW. Early neonatal sepsis increased risk of the development of CP up to 30.8%.
Thus, children with congenital infection, and especially those who have suffered from early neonatal sepsis, constitute a high-risk group for the development of neurological disorders and CP.
Partially hydrolyzed infant formulae for preterm infants: substantiation for their use
The article discusses the rationale for use partially-hydrolyzed infant formulae for nutritional support of preterm infants. Composition of breast milk proteins is highlighted along with some data on pathophysiology of proteolysis in the gastrointestinal tract of preterm infants. Results of the clinical trials and reviews on partially hydrolyzed infants formulae in preterm infants are also discussed with an attempt to define the advantages of the use of infant formulae based on partially hydrolyzed protein in preterm infants.
Clinical significance of milk gangliosides in the regulation of brain and bowel functions in children
Gangliosides are glycosphingolipids that widespread in all tissues and fluids of mammals and humans. They mainly found in ganglion cells of nervous tissue and were named from this issue. Gangliosides important components of plasma membranes and significantly contribute the growth, differentiation of neural networks, immune protection, the formation of a healthy microbiota, the prevention of metabolic disorders (such as obesity, insulin-resistant conditions) and malignant neoplasms. Gangliosides play a significant role in periods of the most active growth and differentiation of body tissues. Breast milk is the main source of gangliosides after birth. They concentrated on the membrane of the milk fat globule. The use of breast milk in the diet of children and milk formula enriched with concentrated membranes of fat globules allow modulating physiological processes during the early development of the child. We speculate that gangliosides can program the health of newborns for the future.
Severe neonatal transimmune thrombocytopenia. Case report
Neonatal immune thrombocytopenia affects newborns from the mothers suffering from autoimmune diseases such as: immune thrombocytopenia (ITP), systemic lupus erythematosus, hyperthyroidism or lymphop-roliferative disorders. Pathogenesis of the disease relay on the transplacental passage of maternal antiplatelet IgG. They destroy fetal/neonatal platelets and can cause a passive disease in a healthy newborn. On the basis of the international medical literature, the risk of thrombocytopenia in neonates born from mothers with ITP can reach up 75%. Nevertheless, the relation between the severity of maternal ITP and the disease in the newborn period was not revealed. The article presents the clinical observation of the term neonate with severe thrombocytopenia due to maternal ITP. The diagnosis built on the basis of the results of a comprehensive clinical and laboratory study of mother and neonate.
Immunomodulation to prevent or treat neonatal sepsis: past, present, and future
Despite continued advances in neonatal medicine, sepsis remains a leading cause of death worldwide in neonatal intensive care units. The clinical presentation of sepsis in neonates varies markedly from that in older children and adults, and distinct acute inflammatory responses results in age-specific inflammatory and protective immune response to infection. This review first provides an overview of the neonatal immune system, then covers current mainstream, and experimental preventive and adjuvant therapies in neonatal sepsis. We also discuss how the distinct physiology of the perinatal period shapes early life immune responses and review strategies to reduce neonatal sepsis-related morbidity and mortality. A summary of studies that characterize immune ontogeny and neonatal sepsis is presented, followed by discussion of clinical trials assessing interventions such as breast milk, lactoferrin, probiotics, and pentoxifylline.
Finally, we critically appraise future treatment options such as stem cell therapy, other antimicrobial protein and peptides, and targeting of pattern recognition receptors in an effort to prevent and/or treat sepsis in this highly vulnerable neonatal population.
The place of antenatal corticosteroids in late preterm and early term births
Infants born in the late preterm period and via non-labour caesarean section in the early term period are at increased risk of respiratory morbidity when compared to their term-born counterparts. The morbidity in these infants is less frequent and severe than in early preterm infants. Antenatal corticosteroids reduce respiratory morbidity in these populations; however, the magnitude of the reduction appears to be small and predominantly in the self-limiting condition of transient tachypnoea of the neonate. The smaller benefit, along with possible harmful effects of corticosteroids, raises a question about the role of antenatal corticosteroids in this population.
Special obstetric populations such as twin pregnancies and pregnancies complicated by diabetes and growth restriction are at increased risk of prematurity and more vulnerable to its complications. Nevertheless, there is limited evidence regarding the benefits of corticosteroids in these populations and potential concern regarding adverse effects. We recommend an individualised approach when administering corticosteroids at later gestations. In these specific obstetric populations, we do not currently recommend.
*1744-165X/ © 2018 Elsevier Ltd. All rights reserved.
Drug therapy during breastfeeding
The importance of breastfeeding for the health of mothers and children does not need to be proven at this time. However, there are many reasons that can prevent full breastfeeding. In particular, drug therapy prescribed during lactation often leads to the temporary discontinuation of breastfeeding, sometimes unreasonable. Often this leads to a loss of breastfeeding in the future. This article highlights the difficulties of prescribing drug therapy during lactation, the contradictions between the existing worldwide recommendations and the instructions for the drug, reflects the current aspects of the pharmacokinetics of drugs in breast milk and gives practical recommendations on the way to solve those problems.
The support of effective lactation and the management of breast milk expression
Breastfeeding is one of the prominent topics of neonatal health care, especially for full-term and premature newborns. Effective lactation and successful breastfeeding depend on the organization of hospital policy for mothers and newborn babies, and breastfeeding counseling. The main task of modern obstetric institutions and hospitals with neonatal care is the implementation of modern technologies for encouragement, support,
and protection of breastfeeding. Principles of the management of breast milk expression in the hospital are discussed in the article. They give the chance to provide breastfeeding for the premature/sick newborns and support lactation when the mothers wean from the babies. The differences between different breast pump models: electric, manual, stationary and individual presented. Advantages of modern electric stationary breast pump Symphony were described. It allows double pumping that effectively stimulates lactation. Effective, safe and comfortable expression of the breast milk in neonatal hospital gives the chance to preserve the lactation effectively. Breastfeeding has a positive influence on mothers' mental state and ability to independently care for the child.
Long-term home oxygen therapy in children. Educational guideline for doctors and parents in questions and answers
Long-term home oxygen therapy is the treatment of choice for various diseases of the children. The method can carry out at home and based on the using of oxygen in the concentration higher than room air. The manual sets out 33 questions and answers on them. The guideline provides answers on the most frequent questions about the oxygen's treatment method. One of the main purposes is a simplification of the dialogue between professionals and parents. The information is presented in an accessible language, avoiding medical terminology whenever possible. Manual is recommended for the education and training process of pediatricians, pulmonologists, neonatologists, rehabilitologists, palliative care doctors, medical students, and residents. Parents of children who need long-term home oxygen therapy are our main audience.
Peculiarities of relations with investigative authorities: ways of solution
In the article peculiarities of relations with investigative authorities in case of difficult situations appearance in obstetric centres, particularly in neonatal units, are discussed.