Objectives. The aims of this study were to assess the efficacy and feasibility of a new, less invasive surfactant administration technique for beractant replacement using a specifically designed cannula in preterm infants born at <32 weeks of gestation and to compare short- and long-term outcomes between this approach and standard treatment, consisting of intubation, administration of surfactant and early extubation to nasal continuous positive airway pressure.

Method. This was a single-center, prospective, open-label, non-randomized, controlled pilot study with an experimental cohort of 30 patients treated with less invasive surfactant administration and a retrospective control group comprising the 30 patients most recently treated with the standard approach. Beractant (4 ml/kg) was administered as an exogenous surfactant in both groups if patients on nasal continuous positive airway pressure during the first three days of life were in need of more than 30% FiO₂ (Clinicaltrials.gov:NCT02611284).

Results. In the group with less invasive surfactant administration, beractant was successfully administered in all patients. 13 (43.3%) patients in the group with less invasive surfactant administration required invasive mechanical ventilation for more than 1 hour during the first 3 days of life, compared with 22 (73%) in the control group (p<0.036). The rate of requiring invasive mechanical ventilation for more than 48 hours was similar between the infants in the two groups (46% vs. 40%, respectively). There were no differences in other outcomes.

Conclusion. The administration of beractant (4 ml/kg) using a less invasive surfactant administration technique with a specifically designed cannula for administration is feasible. Moreover, early invasive mechanical ventilation exposure is significantly reduced by this method compared with the strategy involving intubation, surfactant administration and early extubation.

Ramos-Navarro C., Sanchez-luna M., Zeballos-Sarrato S., Gonzalez-Pacheco N. less invasive beractant administration in preterm infants: a pilot study. Clinics. 2016; Vol. 71 (3): 128-34.

doi: 10.6061/clim'cs/2016(03)02

The peculiarities of the hemostasis parameters children operated in the neonatal period. When covering specific issues of hemorrhagic disorders in newborns. Identify risk factors for thrombotic complications in newborns. Described thrombosis of venous sinus as a problem of the neonatal period. The problems of the epidemiology, diagnosis, prevention and treatment of thrombotic complications in newborns, requiring early surgical intervention.

In this review questions for discussions, problems and achievements in the field of neonatal pulmonology are represented, as well as the contribution of Russian researches in this chapter of neonatology. The prospects for the results implementation and their scientific and practical significance are estimated. The authors in details discussing the most common lung diseases in infants: respiratory distress syndrome, bronchopulmonary dysplasia, and pneumonia. The relevant problem of complications and differential diagnosis of bronchopulmonary dysplasia and other chronic and interstitial lung diseases of newborns, occurring under her mask, were covered.

The study presents data on 24-hour ECG monitoring in 81 preterm infants at a postconceptional age of 37-42 weeks and in 65 normal neonates in the early neonatal period. The 24-hour dynamics of heart rate and corrected QT intervals, circadian index and the incidence of premature beats were evaluated. The preterm infants demonstrated significantly higher parameters of heart rate in the circadian dynamics suggesting a stressed adaptation process, as compared to the healthy children. The preterm infants of different gestational age at birth, extremely low birth weight infants and very low birth weight infants (postconceptional age 37-42 weeks) did not differ between each other in the 24-hour heart ratedynamics. At the postconceptional age of 37-42 weeks, the preterm infants (gestational age -33 weeks) tend to have prolonged corrected QT intervals and higher incidence of the premature beats.

In the article there are described the results of a prospective controlled randomized research held among 336 newborn children, who were accustomed different methods of analgesia by application of medical manipulations with the aim of reduction of algesis. The severity extent of algesis was graded by DAN scale. It was shown that algesis is more expressed among preterm neonates of different gestational age. The means of analgesia are compared to each other by efficiency. The sensory contact with mother at the moment of the manipulation as well as after it is as much efficient as oral application of glucose solution and EMlA cream. Moreover, researchers suppose that the psychological state of mother can have an influence on the efficiency of the sensory contact with newborn child.

The results of the comparative analysis of Rosstat data on the frequency of premature abruptio placentae at early neonatal mortality in 2014. Generally at the Russian Federation, the death of infants in the first 168 hours of life were due to placental abruption in 7.1% of cases. This should be considered when determining the treatment tactics of newborns. More than half (59.3%) cases of placental abruption was noted in the observations of newborn death from respiratory disorders, one-fifth (20.2%) - from the hemorrhagic and hematological disorders, and 14.4% - from infections. In addition, the frequency of premature abruptio placentae as the condition contributing to the death of a newborn, to a certain extent depended on the sex of the child and varied in different Federal districts of the Russian Federation. For clarification of specific links of tanatogenesis is necessary to conduct a clinical-pathological comparisons of autopsy material.

Aim of the study was to determine the frequency of retinopathy of prematurity and to assess the effect of ROP certain risk factors in conditions of level III B perinatal center.

Material and methods. 1003 premature infants data from the ROP risk group with gestational age (GA) of 24­34 weeks (mean GA - 31.27±0.06 weeks) and 450-2240 g body weight (mean birth weight - 1603.08±13.65 g) were included in the study. For greater certainty of the most significant risk factors effect two groups of children were examined: with and without ROP. 1 group consisted of 146 children with ROP, average GA at birth 28.35±0.16 weeks and mean birth weight 1058±24.7 g. Group 2 included 233 children without ROP (average GA at birth 30.3±0.08 weeks, mean birth weight 1363±23.9 g). Exclusion criteria was GA 32 weeks or more and/or birth weight 2000 g or more.

All the children were born in V.I. Kulakov Obstetrics, Gynecology and Perinatology Research Center of Ministry of Healthсаre of the Russian Federation and from the first minutes of life they required to conduct initial resuscitation procedures. After delivery room stabilization children were transferred to V.I. Kulakov Obstetrics, Gynecology and Perinatology Research Center of Ministry of Healthсаre of the Russian Federation neonatal resuscitation and intensive care unit (NICU), where they carried out a standard intensive treatment. The governing principle of respiratory therapy was maintenance of threshold of transition from one type of respiratory therapy to a higher level. Threshold is excess of oxygen non-toxic concentrations (30-40%). Target saturation level corridor was 90-95%. Examination of the eye carried out by ophthalmologists has been made according to the Order of the Ministry of Health of the Russian Federation dd. 25.10.2012 N 442n.

Results. ROP was diagnosed in 150 (15%) children. laser photocoagulation was performed in 12 (8%) children, induced regression was 99%, retinal detachment after laser treatment was observed in 2 children in 3 eyes (1%). Aggressive posterior ROP did not developed. When comparing two groups of children (with and without ROP) the authors obtained following results: children from the 1 group had AlV in 76% of cases, children from the 1 group had AlV in 42.5% of cases (p<0.01). AlV mean duration was 238.1±54.8 hours in group 1, and 31.24±12.6 hours in group 2 (p<0.01). Average duration of CPAP in group 1 was 176±12.4 h, and 81.3±2.5 hours in group 2 (p<0.01). Total duration of respiratory support was 1326.5±11.3 hours in group 1, 105.89±44.1 hours in group 2 (p<0.01). Apnea was in 78.8% cases in group 1, and in 12% in group 2 (p<0.01), the frequency of oxygen saturation drop was 72.6% in group 1 and 32.2% in group 2 (p<0.01). Blood transfusions in group 1 was made on 71% cases and in 15.4% cases in group 2. Retransfusions in group 1 was made in 65% of cases, and were not carried out in group 2 (p<0.01). The average length of stay in the NICU was 38.6±6.2 days of life for group 1, and 15.7±3.2 days of life for group 2 (p<0.01).

Conclusions. ROP frequency was 15%, laser photocoagulation frequency - 8% (for all children with ROP), retinal detachment frequency was 1%. ROP and its severe forms relatively low frequency is associated with child's location in perinatal center at all stages of nursing, and lack of transportation to other hospitals, as well as strictly systematic approach to respiratory therapy implementation in NICU. Blood oxygen saturation drop (desaturation episodes) and repeated apneas, severe congenital infection, which leads to long-term ventilator support, repeated packed red cell transfusions contribute to the ROP development.

Respiratory distress syndrome of the newborn (RDSN) is one of the most common pathological conditions recorded in preterm infants during the early neonatal period. On the basis of insightful assessment of lung oxygen consumption, efficiency of oxygen administration and tissue oxygenation levels it is possible to develop new diagnostic approach that allows to individualize RDSN treatment and to prevent complications of the disease during early stages.

Aim. Assess the nature and directionality of oxygen status changes in preterm infants with respiratory distress syndrome in first hours and days of life. To identify factors that impact the effectiveness of standard medical interventions for extremely preterm infants condition stabilization.

Material and methods. Scientists has conducted the comprehensive assessment of respiratory and cardiovascular system basic clinical parameters dynamics, including insightful oxygen status assessment analysis in 34 infants with gestational age of 24-34 weeks. All the child study group required initial resuscitation in delivery room. Oxygen status was evaluated during first 15-20 minutes after birth, and every 6 hours after child admission in the neonatal intensive care unit until condition stabilization. Than it was evaluated daily at least 3 times a day until the end of the first week. Along with the oxygen status changes assessment regularly (every 10-15 minutes) oscillometric blood pressure measurement was conducted.

Results. Significant role of tissue hypoxia in pathogenesis of multiple organ dysfunction in preterm infants with RDSN was identified. Clinically informative arterial blood oxygen status lab test values were studied, which can be recommended for objectively intensive care effectiveness monitoring.

Conclusion. Increasing the use of insightful oxygen status assessment in neonatology practice will allow not only timely predict severity of a variety of diseases, but also prevent acute metabolic complications in critically ill neonates.

Aims. To analyse perinatal factors that influence to the birth the infants born 34-36 weeks gestation; to study the structure of diseases among late preterm infants and to determine their need in Neonatal Intensive Care Unit (NICU) and hospital care.

Material and methods. the material for the study included all mothers and their late preterm infants: 34 0/7 to 36 6/7 born in V.I. Kulakov Obstetrics, Gynecology and Perinatology Research Center of Ministry of Healthcare of the Russian Federation, Moscow in the period from 2013 to 2015. The course of pregnancy and delivery, the type of delivery, applied preventive measures and treatment, as well as the clinical state of infants were all analysed.

Results. The vast majority of women with premature delivery were complicated with somatic and obstetric history. The most common factors affecting the foetus during gestation and delivery were the threat of early pregnancy termination, urogenital infections, preeclampsia, multiple pregnancy, premature rupture of mem­branes.

The most common pathologies in infants during the hospital stay were respiratory distress, hyperbilirubinaemia, inborn infections and hypoxic-ischemic lesion of the central nervous system. 28.7% of late preterm infants observed in our center, were admitted to the NICU, and demanded respiratory therapy (26% of late preterm infants demanded non-invasive respiratory support, 10.7% - artificial lung ventilation) and adminis­tration the surfactant in some cases (1.9%). Our study found that all infants born at 34 weeks gestation, 72.7% of infants born at 35 weeks gestation and 34.3% of infants born at 36 weeks gestation required medical care in NICU. 51.2% of late preterm required hospital care during period of early neonatal adaptation.

Conclusions. Thus, about one-third of late preterm infants required specialized medical care in a NICU in the first days after birth; more than half of late preterm infants demanded hospital care. late preterm infants should be followed closely for the complications just after birth, and preventive strategies and clinical guidelines for the care of late preterm infants should be developed.

Aim. Effectiveness and safety analysis of donor human milk banks functioning on the basis of department of premature and newborn babies of multidisciplinary pediatric center.

Study design. This is an open prospective-retrospective cohort study of donor human milk bank function­ing importance within 18 months of its operation in neonatal hospital in the area of breastfeeding promotion, enteral nutrition optimization, hospital-acquired infections prevention.

Material and methods. 123 lactating mothers were examined (120 women have become donors). Self-report survey and microbiological (culture) study of breast milk before and after pasteurization were administered. There was 125 donated breast milk recipients (clinical and anamnestic data, starting date and enteral nutrition build-up rates, dynamics of body weight and microbiological monitoring data analysis). There was 20 children in the com­parison group with similar distribution by maturity degree and nature of pathology. All of them were observed in hospital one year before donor human milk bank opening. Statistica 6.0 software package was used for statistical analysis. Mann-Whitney U-test was used to calculate non-parametric data validity.

Results and discussion. Donor human milk availability in children active treatment group allowed to re­duce the proportion of newborns that received milk formula at the beginning of hospitalization on ²/₃. In case of donor breast milk administration age at the onset of enteral feeding was reduced by an average of 50 hours; time of central venous catheter administration and device-related infections risk also were reduced. Full en­teral feeding access time also reduced significantly. After donor human milk bank opening in case of discharge 85% of preterm infants received exclusive breast feeding. During the period of donor human milk bank working, breast milk substitutes usage in the department reduced by ²/₃ unit.

Conclusion. Preliminary evidence indicate about safety and sufficient of donor human milk utilization ef­ficiency in optimal nutritional status and clinical symptoms of perinatal pathology in hospitalized preterm infants dynamic supply, that can reduce non-communicable diseases risk, decrease the time of full enteral feeding transfer and the duration of hospitalization. Donor human milk bank functioning in hospital contributes to support and promotion of premature breastfeeding (including extremely low birthweight infants breastfeeding).

Poland syndrome is a rare congenital disease, which manifests itself during early neonatal period with only visible deformation of upper limbs and chest. In this review you cane find description of a rare combination of Poland syndrome with gastroschisis in a clinical case of the disease in case of newborn with gastroschisis that was diagnosed at 22 weeks of gestation. This review also provides definition, symptomatology and basis of disease etiopathogenesis, diagnosis and treatment.

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).