Objectives. To test the hypothesis that a patent ductus arteriosus (PDA) severity score (PDAsc) incorporating markers of pulmonary overcirculation and left ventricular (LV) diastolic function can predict chronic lung disease or death before discharge (CLD/death).

Study design. A multicenter prospective observational study was conducted for infants <29 weeks gestation.

An echocardiogram was carried out on day 2 to measure PDA diameter and maximum flow velocity, LV output, diastolic flow in the descending aorta and celiac trunk, and variables of LV function using tissue Doppler imaging. Predictors of CLD/death were identified using logistic regression methods. A PDAsc was created and a receiver operating characteristic curve was constructed to assess its ability to predict CLD/death.

Results. We studied 141 infants at a mean (SD) gestation and birthweight of 26 (1.4) weeks and 952 (235) g, respectively.Five variables were identified that were independently associated with CLD/death (gestation at birth, PDA diameter, maximum flow velocity, LV output, and LV a0 wave). The PDAsc had a range from 0 (low risk) to 13 (high risk). Infants who developed CLD/death had a higher score than those who did not [7.3 (1.8) vs 3.8 (2.0), p<0.001]. PDAsc had an area under the curve of 0.92 (95% CI 0.86–0.97, p<0,001) for the ability to predict CLD/death. A PDAsc cut-off of 5 has sensitivity and specificity of 92% and 87%, and positive and negative predictive values of 92 and 82%, respectively.

Conclusions. A PDAsc on day 2 can predict the later occurrence of CLD/death further highlighting the association between PDA significance and morbidity.

In preterm infants, poor postnatal growth is associated with adverse neurocognitive outcomes; conversely, rapid postnatal growth is supposedly harmful for future development of metabolic diseases.

Conclusion: In this systematic review, observational studies reported consistent positive associations between postnatal weight or head growth and neurocognitive outcomes; however, there was limited evidence from the few intervention studies. Evidence linking postnatal weight gain to later adiposity and other cardiovascular disease risk factors in preterm infants was also limited.

Acta Paediatrica. 2015; Vol. 104: 974–86.

DOI: 10.1111/apa.13128

Hypoxic-ischemic encephalopathy (HIE) is one of the most urgent problems of neonatology, due to the high prevalence of the consequences in the form of mortality and disability in children. Evolving hours later brain damage secondary to activation of glutamate stress, calcium stress, free radical damage, aseptic inflammation, and activation of apoptosis increases cerebral damage. One of the promising methods to reduce the risk of adverse consequences of HIE is therapeutic hypothermia. The article describes the main pathogenetic mechanisms of secondary neuronal damage and the effect of hypothermia on their course. Justify the choice of the optimal mode of hypothermia: start in the first 6 hours of life, the depth of 33–34 °С and duration 72 hours. Choosing the best method (total or cranial) remains debatable issue due to the lack of studies comparing them directly. The clinical research and systematic reviews support the efficacy of hypothermia cerebroprotective action after suffering a HIE.

Nutritional status of premature and critically Ill infants is very important for development of bronchopulmonary dysplasia (BPD). Nutritional disorder is a complication of BPD and a very important pathogenetic mechanism at the same time. Nutritional support can modify state of the disease, and prevent its development in some cases. In this review modern data about occurrence; causes; influence of eating disorders on BPD development; patients needs for energy, nutrients, macro- and micronutrient elements and vitamins are presented. Separately nutritive strategies that affecting on the disease development, as well as features of parenteral and enteral nutrition for children with BPD are described. Recommendations for nutritional status monitoring and control of enteral nutrition effectiveness are given. In conclusion, recommendations for nutritional support of infants with respiratory distress syndrome and BPD (unfavorable outcome) are evaluated from the standpoint of evidence based medicine.

In the present review different methods for surfactant administration during continuous positive airway pressure (CPAР) are considered. There is good evidence base that early CPAP from birth is feasible and safe even in very preterm infants. However some of newborns will develop RDS which will demand surfactant administration further. Combination of two techniques, noninvasive ventilation and selective surfactant administration, allow to guarantee good outcomes. Open are questions about optimal time and a way of surfactant administration, and also prediction of its insufficiency.

Aim. The aim of the study was to determine whether leukocytosis is an important diagnostic marker for infection process in premature neonates older than 72 hours of age when there are no other inflammatory markers.

Material and methods. In the historical cohort study analysis of 158 case histories of premature neonates older than 72 hours of age, received medical treatment in NICU from December 2012 to October 2014, was made. In such a case all episodes of clinical deterioration in newborns with suspected manifestation of inflammatory infections came into account.

Altogether 86 cases suspected of inflammatory infections progression in 73 preterm infants older than 3 days of life were identified. Of these, in 11 children during their stay on the Neonatal Intensive Care Unit (NICU) these episodes were noted twice and three times in 1 case.

All cases of examination on inflammatory infection progression were divided into 4 groups depending on the presence or absence of infectious disease and peripheral blood leukocyte count. The 1st group consisted of 24 episodes with suspected inflammatory infection progression, the only manifestation of which was leukocytosis, in the absence of other signs of systemic inflammatory response with further progression of a typical clinical picture 72 hours later after study. Group 2 consisted of 17 leukocytosis episodes, that were not accompanied by inflammatory infection progression in a range of 72 hours before or after detection of these changes in clinical blood test. The third group consisted of 23 episodes of children health reduction when there were clinical and laboratory signs of systemic inflammatory response that required antibacterial therapy, however, leukocyte count was normal. 4th group consisted of 22 episodes with suspected inflammatory infection manifestation (leukocytosis was not observed and infectious process was excluded during following clinical observation and examination).

To evaluate the leukocytosis diagnostic informative as diagnostic marker for inflammatory infection in premature neonates older than 72 hours of age the authors calculated diagnostic marker operating characteristics (sensitivity, specificity, diagnostic efficiency, positive and negative results prognostic value). Leukocytosis occurs when the count becomes greater than 20×109/L in premature neonates older than 72 hours of age. The authors used diagnostic standard adopted for Newborn Intensive Care Unit of the "V.I. Kulakov Obstetrics, Gynecology and Perinatology Research Center" for newborn screening for suspected infectious pathology.

Results. Sensitivity of leukocytosis as an early marker of inflammatory infection in infants older than 72 hours of age was 53%. Specificity of this index is equal to 59%. Also such characteristics as diagnostic effectiveness (53.4%), positive predictive value (51%) and negative predictive value (56%) for leukocytosis as a criterion for inflammatory infection in premature neonates older than 72 hours of age did not exceed 60% .

Conclusion. These results indicate that leukocytosis in premature neonates older than 72 hours of age is not an important diagnostic marker for inflammatory infection due to its low sensitivity and specificity, and it can not be basis for antimicrobial therapy. High white blood cell count is an indication for an extended examination of the child.

Aim. Assess the clinical efficacy of autologous packed red blood cells administration from umbilical blood for anemia correction in newborns with gastroschisis in postoperative period.

Methods. Transfusion of washed autologous packed red blood cells administration from umbilical blood was performed after special training. Blood sampling was carried out after delivery of a child and closed technique omphalotomy by a vein puncture distal (placental) end of a navel by the drainage needle which is a part of special transfiusion system. Further autologous umbilical blood in the marked containers was pitched in branch of gravitational surgery of blood and then it was put on storage at +4 °C for 21 day for further analysis and transfusion. Directly ahead of autotransfusion umbilical blood was pitched in branch of gravitational surgery of blood where its centrifiugal separation on erythrocyte mass and plasma was made. Then concentrated red cells was exposed to washing out in sterile physiological solution and a filtration through the micromodular filter. Then the marked package with the washed erythrocytes was pitched in branch of surgery of newborns for the purpose of further autotransfusion under indications. The transfusion autoerythrocytes was made according to reacting at the moment of carrying out of work to orders of Ministry of Health of the Russian Federation: to the Order of Ministry of Health of the Russian Federation from November, 25th, 2002 No 363 "About the statement of the Instruction on application of components of blood" and to the Order of Ministry of Health of the Russian Federation from April, 2nd, 2013 N 183n «About the statement of rules of clinical use of donor blood and (or) its components».

Results. In the department of surgery, intensive care and Newborn Intensive Care Unit of «Research Center for Obstetrics, Gynecology and Perinatology» in the period from 2007 to 2015 for the purpose of anemia correction autotransfusion of washed packed red blood cells from umbilical blood of 21 newborns with gastroschisis was made. In all cases, there were no post-transfusion reactions in children. In the majority (81%) of cases volume of prepared and transfused autologous packed red blood cells was sufficient for anemia relief, and only 19% of infants with anemia further required additional transfusions of donated red blood cells. As a result of transfusion, according to clinical blood analysis data, hemoglobin and hematocrit levels trended upward, values of biochemical blood assay and common urine examination were within the expected range for age.

Conclusion. Autologous packed red blood cells administration from umbilical blood of newborns with gastroschisis in postoperative period will increase infusion-transfusion treatment options in children of this category, being, in fact, the only comparable in effectiveness and the most safe donated blood alternative.

Objective: this study was aimed to compare successful extubation in the two rate of mechanical ventilation of less 20 breaths/min and more 20 breaths/min when removing the neonates from the ventilator.

Study design: this was a retrospective, cohort study of 145 neonates born at 25 to 42 weeks of gestation performed in "V.I. Kulakov Obstetrics, Gynecology and Perinatology Research Center of Ministry of Healthcare of the Russian Federation", Moscow, from 2006 to 2010. A total of 145 infants with respiratory distress syndrome or congenital pneumonia subjected to mechanical ventilation were assessed. One group was extubated with the rate of ventilator of less 20 breaths/min and the other with more 20 breaths/min. There were no statistically significant differences between two groups at the study entry.

Results: the length of mechanical ventilation, extubation failure rate and the using of sedative medication was lesser in the first group (more than 20 breaths/min) than in the control group of less 20 breaths/min, and those differences were statistically significant (p<0.05). Difference between the rate of respiratory complications between two groups was not statistically significant (p>0.05). The rate of different hemorrhages was higher in the second group.

Conclusion: The results of our study show that extubation of the neonates with the rate of ventilator more than 20 breaths/min is safe and effective. This reduced the length of mechanical ventilation, the frequency of sedation. Although the rate of hemorrhages decreased that might contribute in the reduction of disability related to it. These data are supported by up-to-date clinical trials.