Complex assessment of factors that adversely affect the functional state of the brain of newborn children with congenital malformations of internal organs

• Teberdieva S.O.
• Lyubov’ V. Ushakova
• Safanovskaya A.A.
• Artem A. Burov
• Yulia L. Podurovskaya
• Dmitriy N. Degtyarev

Abstract

The purpose of the study: a complex assessment of factors that adversely affect the functional state of the brain of children who underwent surgery in the neonatal period.

Material and methods. The study included 79 full-term newborns with malformations of internal organs, borned in V.I. Kulakov Obstetrics, Gynecology and Perinatology Research Center of Ministry of Healthcare of the Russian Federation. Patients were divided into 2 groups: the study group included 40 newborns with signs of perinatal brain lesion; the control group consisted of 39 newborns, without signs of central nervous system (CNS) lesions. All patients underwent surgery under general anesthesia for the main disease, in the period of newborns. After the surgical treatment 100% of children underwent postoperative anesthesia with 3 combinations of drugs: 1) two or more narcotic analgesics, 2) one narcotic ± non-narcotic opioid analgesic, 3) non-narcotic opioid analgesic. Evaluation of the brain was based on the examination by neurologist and neurosonography. COMFORT and CRIES scales were used to evaluate the effectiveness of anesthesia throughout the observation period.

Results. Most often, CNS dysfunction was associated with congenital diaphragmatic hernia (CDH) (22.5% in the study group versus 0% in the control group) and gastroschisis (22.5% in the study group versus 7.7% in the control group). Also, patients with CDH required a complex postoperative analgesia with a combination of 2 or more narcotic analgesics. According to the results of pain assessment on the COMFORT and CRIES scales, postoperative analgesia was effective in both groups. It was reliably revealed that in the study group children spent longer on mechanical ventilation, and they also performed repeated surgical interventions more often.

Conclusions. In newborns with congenital malformations of internal organs, requiring early surgical intervention, the cause of violations of the functional state of the central nervous system is not so much the use of narcotic and non-narcotic analgesics, but rather the influence of a complex of unfavorable factors.

Keywords:newborn, central nervous system, postoperative analgesia, congenital malformations

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