We review meta-analysis of the relationship between probiotic usage and late-onset sepsis in preterm infants development. The review provides epidemiological data on the prevalence of late-onset neonatal sepsis in various regions of the world. There are an assesses of the main preventive measures effectiveness, efficacy evaluation of basic prevention measures, comparison of clinical informativeness of individual laboratory tests. This review includes diagnostic screening for late-onset neonatal sepsis methodology description.

Aim. Despite significant proposed benefits, delayed umbilical cord clamping (DCC) is not practiced widely in preterm infants largely because of the question of feasibility of the procedure and uncertainty regarding the magnitude of the reported benefits, especially intraventricular hemorrhage (IVH) vs the adverse consequences of delaying the neonatal resuscitation. The objective of this study was to determine whether implementation of the protocol-driven DCC process in our institution would reduce the incidence of IVH in very preterm infants without adverse consequences.

Study design. We implemented a quality improvement process for DCC the started in August 2013 in infants born at ≤32 weeks' gestational age. Eligible infants were left attached to the placenta for 45 seconds after birth. Neonatal process and outcome data were collected until discharge. We compared infants who received DCC who were born between August 2013 and August 2014 with a historic cohort of infants who were born between August 2012 and August 2013, who were eligible to receive DCC, but whose cord was clamped immediately after birth, because they were born before the protocol implementation.

Results. DCC was performed on all the 60 eligible infants; 88 infants were identified as historic control subjects. Gestational age, birthweight, and other demographic variables were similar between both groups. There were no differences in Apgar scores or admission temperature, but significantly fewer infants in the DCC cohort were intubated in delivery room, had respiratory distress syndrome, or received red blood cell transfusions in the first week of life compared with the historic cohort. A significant reduction was noted in the incidence of IVH in the DCC cohort compared with the historic control group (18.3 vs 35.2%). After adjustment for gestational age, an association was found between the incidence of IVH and DCC with IVH was significantly lower in the DCC cohort compared with the historic cohort; an odds ratio of 0.36 (95% confidence interval, 0.15-0.84; p<0.05). There were no significant differences in deaths and other major morbidities.

Conclusion. DCC, as performed in our institution, was associated with significant reduction in IVH and early red blood cell transfusions. DCC in very preterm infants appears to be safe, feasible, and effective with no adverse consequences.

Information about the methods for early detection of congenital heart diseases in neonates, which are used in the world practice as a screening technology, is presented in this review. The urgency and importance of screening for congenital heart disease in the early neonatal period as a way to reduce infant mortality were shown.

Special attention is given to the targeted clinical examination of the neonate and blood pressure measure­ment for early detection of different cardiac pathologic conditions. It emphasizes the need for supplement of clinical examination methods during the early neonatal period of the screening of blood oxygen saturation.

It emphasizes the need for supplement of clinical examination methods during the early neonatal period with the blood oxygen saturation screening. The most detailed information is provided about blood oxygen saturation screening in neonates, about the advantages and disadvantages of the method, its sensitivity and specificity, about the benefits of the more later pulse oximetry screning in neonates for detection of critical congenital heart diseases, and also information about analysis of the false positive and false negative results, and methods to reduce them.

The review provides information on the basics of traditional neonatal mechanical ventilation, and the prospects for its development. The basic aspects of modern mechanical ventilation in newborns, new strategies, algorithms, types and modes of mechanical ventilation that increase the efficiency and safety of this method of intensive respiratory support. In particular, it provides information on the introduction into clinical practice of new types of ventilation (ventilation with dual controls - in volume and pressure) and new respiratory program - controlled ventilation with a tidal volume.

The results of the analysis of Rosstat data for 2010 and 2014 about stillbirths and early neonatal deaths due to congenital pneumonia are shown. In 2014, congenital pneumonia was the initial cause of death in 0.35% of cases of stillbirth and of 8.34% of newborn deaths at the first 6 days of life. The frequency of deaths from congenital pneumonia and factors contributing to its development varies in different Federal districts of the Russian Federation. A role in the development of congenital pneumonia playing infectious diseases of mother, as well as inflammatory lesions of the placenta.

Respiratory syncytial virus (RSV) is one of the leading etiological agents of respiratory infections in children of early age. The greatest risk of the severe RSV disease exists in the following groups of patients: premature infants; children with chronic lung diseases, particularly with bronchopulmonary dysplasia (BPD) and cystic fibrosis; pathology of the cardiovascular system; neuro-muscular diseases; immunodeficiencies.

Aim - analysis of clinical, laboratory, and radiological features of the course and therapy of RSV bronchiolitis in the real clinical practice in preterm infants and children with BPD; to identify the predictors of severe course of RSV bronchiolitis in premature infants.

Material and methods. Analysis of the medical records of 40 patients who had RSV bronchiolitis in Moscow in 2011-2015.

Results. We demonstrated that preterm infants with or without BPD belong to the group of a high risk of severe RSV infection who may require intensive care, oxygen therapy and mechanical ventilation. Also we identified predictors of severe RSV bronchiolitis in premature infants.

Conclusion. Taking into account the vulnerability of children from the high risk group we can conclude that there is a strong need in RSV prophylaxis that should be provided both in NICUs and in community hospitals.

Arterial hypotension is a common problem in NICU. The incidence of arterial hypotension is 16-52%. Reduced perfusion of organs such as the brain, kidneys, heart, and gastrointestinal tract may lead to acute dysfunction and be associated with permanent injury. Various therapeutic strategies are used for cardiovascular support, including volume expansion, inotropes, corticosteroids. But the initiating therapy has traditionally been volume expansion. As we know, AH is poorly correlated to blood volume in preterm infants and hypovolemia is a rare reason of AH, especially in extremely preterm newborns. Also the excess volume expansion in condition of PDA can lead to deterioration of respiratory problems. The aim of our study was: to compare two ways of therapy of AН - Dopamine and volume expansion in ELBW.

Material and methods. Criteria of inclusion were: ELBW + Arterial Hypotension (Mean BP<GA in weeks). Criteria of exclusion were: congenital anomalies, obvious signs of a hypovolemia and shock. Randomization: odd-numbered infants received Dopamin and even-numbered - Normal saline. Intervention: Dopamine starting from 2 pg/kg/min with dose increase until BP became normal (BP>GA), NS - 10 ml/kg in 30 min. Sometimes one, sometimes two boluses were used, but never more, than two. If NS was inefficient, Dopamine was prescribed. We checked efficiency of therapy (BP normalization (mBP>GA)) after one hour, Diuresis (before/after intervention, within a day), effective dose of Dopamine (if needed), total dose of Dopamine within a week, total duration of inotrope support. Also we evaluated the heart hemodynamics (CO, EF, SF) and regional hemodynamics in АСА, AMS (Ri, Tamx, Pi, MD), blood sample (pH, lactate, BE, HCO3) and outcomes (PDA, MV duration, BPD, NEC, PVL, mortality before discharge, stay in NICU) 41 newborns were accepted according to the criteria of inclusion, 2 was excluded due to congenital heart diseases. 2 groups were founded (18 in NS group, 21 - Dopamine group).

Results. After one hour the mean BP was higher than GA in all newborns from Dopamine group (100%) and 38.8% in NS group exhibited the need for Dopamine for BP normalization. There were increasing of the diuresis and ejection fraction in both groups after infusion. The cerebral, renal and mesenterial blood flow were normalized. We found out that in the Dopamine group the cardiac output (CO) didn't increase, but in NS group the CO increased more, than 1, times. At the same time the efficiency of Dopamine in normalising the BP was 100%, and efficiency of the isolated volume loading - 61.2%. The effective daily dose of Dopamine (if needed), pg/kg/min was significantly higher in those, who had previously received NS (3.6±0.63 vs 1.85+0.64, p<0.0001) Duration of mechanical ventilation and observing in NICU was more in NS groupe, than in Domamine group (p=0.02 and p=0.03). Children from NS group had the bigger diameter of PDA also (1.6±1.44 vs 2.6 +1.47, p=0.04).

Conclusions. Dopamine was more effective in BP normalization than isolated NS for ELBW. If Dopamine was required, the dose sufficient for pressure normalization was higher for newborns who had previously received NS. Dopamine increases EF more effectively, but NS increases CO more effectively. Dopamine and NS are equally effective in blood flow normalization in ACA, AR, AMS. The incidence of sPDA and severe BPD were higher in newborns who received NS for AH treatment. The duration of MV and stay in NICU were longer for newborns who received NS for AH treatment.

The aim. Of this study was to investigate the features of reactive oxygen species (ROS) production by phagocytic ceLLs in peripheraL bLood of newborn infants in the earLy neonataL period depending on their gestationaL age and cLinicaL condition.

Material and methods. Prospective study was performed on bLood sampLes from 65 newborns: 48 preterm infants with respiratory diseases and 17 heaLthy fuLL-term newborns. The intensity of zymosan-induced ROS production was determined by chemiLuminescence method. LuminoL- and isoLuminoL-dependent chemiluminescence was identified in the first hours of Life, the third day of Life and at the end of the early neonataL period (seventh day of Life) of preterm newborns.

Results. The intensity of ROS production by peripheraL bLood phagocytes of newborns is significantly affected by gestational age. Both extra- and intraceLLuLar ROS production was decreased at birth in newborns with diseases of the respiratory system characterized by the deveLopment of systemic infLammation. It was shown that the differences in the functional activity of ROS-producing cells in preterm infants disappear by the third day of Life.

Human metapneumovirus - a relatively recently discovered virus that causes the symptoms of acute respiratory disease. The paper presents the clinical and epidemiological characteristics of metapnevmovirus infection in children, demonstrates features of the course of the infection in preterm infants and infants, which are characterized by frequent development of bronchiolitis. Demonstrate the own clinical observation of nosocomial metapnevmovirus infection of the child with extremely low birth weight with severe bronchopulmonary dysplasia and acquired form of cytomegalovirus infection.

Despite the stable epidemioLogicaL situation of syphiLis among women of chiLdbearing age and pregnant women, diagnosis and prevention of congenitaL syphiLis in the newborn is stiLL the issue of the day. EarLy congenitaL syphiLis has not aLways typicaL features that creates difficuLties in its recognition. The article presents the cLinicaL cases of congenitaL syphiLis, occurs in the form of septic process and «cLassicaL» manifest form.