Objective. To assess the association between serum 25-hydroxyvitamin D (25OHD) LeveLs and outcomes in preterm infants (<32 weeks gestation).

Study design. Serum 25OHD was measured in mothers and their infants within 24 hours of birth, before the start of enteraL vitamin D suppLementation, and at discharge from the neonataL intensive care unit. We evaLuated the associations between vitamin D status and various earLy preterm outcomes.

Results. Ninety-four preterm infants and their mothers were incLuded; 92% of the infants had a 25OHD LeveL #50 nmoL/L (20 ng/mL), and 64% had a 25OHD LeveL <30 nmoL/L (12 ng/mL). A Low 25OHD LeveL (<30 nmoL/L) in preterm infants at birth was associated with increased oxygen requirement (p=0.008), increased duration of intermittent positive-pressure ventiLation during resuscitation at deLivery (p=0.032), and greater need for assisted ventiLation (p=0.013).

Conclusion. We observed a high prevaLence of Low 25OHD (<30 nmoL/L), and found an association between vitamin D status and acute respiratory morbidity in preterm infants after birth.

Ultrasound investigation allow to identify structural brain changes during perinatal hypoxic ischemic lesions of the central nervous system in newborns. Ultrasound and pathomorphological data analysis suggests that character of ischemic cerebral affection depends not only on the severity of perinatal hypoxia, but also on the child ripeness level. In term infants perinatal ischemia leads to elective neuronal necrosis, subcortical and multicystic encephalomalacia, cerebrovascular accidents. Severe perinatal hypoxia in premature infants (born at 35 to 37 weeks gestation) may lead to periventricular leukomalacia development. In connection with extremely low birth weight infants nursing during ultrasound investigation physicians detected ischemic cerebral affection forms more frequently. For example: as diffuse leukomalacia and periventricular hemorrhagic infarction, and thay should be differentiated from periventricular leukomalacia.

Functioning ductus arteriosus is one of the most frequent complications of neonatal period in premature infants. The relationship between the functioning arterial duct and morbidity in newborns is a sufficient reason for the early conservative closure. However, the use of NSAID to close the ductus arteriosus showed its selective effect, especially in a cohort of infants with extremely low birth weight.

The purpose of the research is to establish hemodynamic predictors of the effectiveness of conservative treatment of the functioning ductus arteriosus with nonsteroidal antiinflammatory drugs in infants with extremely low birth weight to determine the therapeutic tactics.

Material and methods. The study included 41 neonates with a functioning arterial duct, established on the basis of echocardiographic and Doppler examination. According to the protocol, all the newborns received therapy with ibuprofen. In 33 newborns ductus arteriosus closed (Group 1), and in 8 babies (group 2) because of treatment failure surgical correction of this condition was made. In order to establish the factors determining the effectiveness of the therapy of newborns in group 1, a comparative analysis of medical history, clinical, instrumental and laboratory parameters of newborns in studied groups.

Results. On the basis of the laws of hemodynamics and conducted mathematical analysis it was related, high values of maximum blood flow in the ductus arteriosus and diastolic blood pressure, and low values of the ratio of the left atrium to the aortic root with the success of medical closure of the ductus arteriosus in newborns with extremely low birth weight.

Conclusions. In the research it was defined for the first time that the maximum rate of blood flow in the ductus arteriosus and the ratio of left atrium to aortic root are hemodynamic predictors of effective conservative therapy closure of the ductus arteriosus in newborns with extremely low birth weight: On the basis of these indicators suggested nomogram, which will allow to estimate the probability of closing Blood flow graph-analytical method for the 2nd day of life. When the probability is less than 50%, the closure of the ductus arteriosus of the nomogram, surgical closure of the flow may be recommended.

Nursing preterm infants with intrauterine growth retardation is an actual problem of neonatology at the high rate of perinatal disorders and neuropsychiatric physical development of infants in this population. Despite the increase in the number of studies examining the characteristics of the electrical activity of the brain in premature babies, including delayed fetal development, the results are ambiguous and remain the subject of debate.

The aim of the research was to assess the stress-realizing (the content of ACTH, cortisol) and stress-limiting (the content of β-endorphin and melatonin) systems in infants depending on the type of feeding and conditions of hostilities.

Materials and methods. Under supervision there were 58 infants and their mothers in the zone of military conflict. Among them: the 32 infants who were breast-fed, formed the core group of infants and their mothers, and 26 infants who were bottle-fed, formed the comparison group infants and their mothers. The control groups in the study consisted of 28 breastfeeding infants and their mothers, and 32 infants being on artificial feeding and their mothers.

The content of cortisol, ACTH and β-endorphin were determined by ElISA. The content of melatonin in the body was judged by the concentration of its main metabolite-6-sulfatoximelatonine (6-COMT) in the urine.

Conclusions. In infants who were breast-fed in the zone of military conflict there was a proportional increase in neurotransmitters both stress-realizing and stress-limiting directions, while in infants on artificial feeding there was a significant increase of the stress-realizing neurotransmitters (cortisol and ACTH) over stress-limiting (melatonin, β-endorphin). Circadian rhythm disorders in infants who were bottle-fed in a combat zone was manifested by the increase in melatonin ratios: day/night compared both in the control group and in the main group.

The study of neuropeptides in mothers showed the prevalence of the stress-realising content of the neurotransmitters (cortisol and ACTH) over the stress-limiting (melatonin, β-endorphin) hormones during the artificial feeding, that may indicate the increasing of the stress resistance of the body of breastfeeding mothers.

Pathology of the lymphatic system in newborns-are quite rare condition. However, within six months in the intensive care unit newborns in dty children's hospital # 1 we watched 4th case of chylothorax. The therapy is used as surgical techniques (thoracentesis, chest tube) and conservative treatment (infusion of octreotide, sildenafil, special therapeutic composition for enteral nutrition). The article describes in detail the cases of clinical experience, the treatment, the literature review.

This article is dedicated to developmental perspectives of follow-up service for very premature infants in Russian Federation. Authors give examples of calculation of time spending to child examination in ambulatory, in dependence on age and concomitant diseases. The management of follow-up system and qualifying characteristic of pediatricians were shown.

An article represents the particular approach to nutritional support in very low and extremely low birth weight preterm infants. The current practice of premature infants nutrition should bring the baby to the growth rate of fetal gestational age, respectively to maintain normal concentration of nutrients in the blood and tissues. Early nutrition especially colostrums and breast milk is essential for the maturation of gastrointestinal tract, preventing infections, necrotizing enterocolitis, and other life-threatening conditions. Human breast milk cannot fully ensure an adequate amount of nutrients for growth and development of premature baby. The article presents the practical application of human milk fortifier. lack or insufficient amount of human milk is an indication for use of special formulas for feeding of preterm infants. It shows the composition of and indications for the use of formula with partially hydrolysed protein.

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.