Premature infants need to be pharmacologically treated by hemodynamically significant patent ductus arteriosus in 43-76%. Surgical closure of patent ductus arteriosus will be provided to the non-responded newborns. The efficiency of the medical treatment depends on multiple factors. Therefore, knowledge of physiology on ductus arteriosus is an important for a nursing of extremely premature infants.

Aim of study: to find out useful predictors of the successful pharmacological therapy of hemodynamically significant patent ductus arteriosus in preterm infants by retrospective analysis.

Material and methods. 70 premature infants with patent ductus arteriosus who received medical treatment by intravenous Ibuprofen were included in the study. Patients were divided into 2 groups: Group A - efficient medical treatment (n=31) and Group B - non-efficient medical treatment (n=39). Statistical analysis of clinical and laboratory indicators was performed to determine the correlation with the efficacy of Ibuprofen. We obtained the boundary value of the laboratory parameters that affect the medical treatment.

Results. Survival rate was 87.4% and efficiency of medical treatment was 68.6% for all patients. The body weight (BW) and gestational age (GA) were statistically significant between 2 study groups.

Group A 114.23±140.26 (g) vs group B 901.00±216.16 (g) (p<0.001); group A 28.20±1.21 vs group B 26.31±2.08 (p<0.001). Moreover, we revealed that red blood cell count, level of hemoglobin (Hb) and hematocrit level (Ht) were statically significantly higher in Group A. Red blood cell count 4.41±0.77x10⁹ vs 3.55±0.64x10⁹ (p<0.001), Hb 162±26.26 vs 117.21±77 g/l (p<0.001), Ht 44.99±8.43 vs 34.05±6.90% (p<0.001). Mathematical analysis was shown the correlation between the hemoglobin and hematocrit level and efficacy of Ibuprofen treatment. PDA closure more than 82% has had the newborns with Hb 144 g/l and Ht 42% respectively.

Conclusion. High levels of hemoglobin and hematocrit in premature infants increase PDA closure rate.

Aim. To compare levels of growth factors, chemokines, proinflammatory and anti-inflammatory cytokines in blood in the first day of life of premature newborns with infectious and non-infectious respiratory diseases.

Material and methods. Concentrations of 17 cytokines were examined by multiplex assay in the plasma of peripheral blood of 63 premature newborns in the first day of life.

Results. In the group of newborns with the gestational age (GA) of 32 weeks the concentration of chemokines IL-8 and MSR-1 were higher in subgroup of congenital pneumonia vs. respiratory distress syndrome (RDS). The level of IL-13, IFNγ, IL-12, IL-17, IL-1β, TNF-α, IL-8 and MSR-1 were statistically significant in newborns with early onset sepsis (EOS) versus in subgroup with RDS. Concentration of TNF-α was higher in plasma of infants with EOS in comparison with the newborns in with congenital pneumonia. The level of IL-13 for newborns with GA 32-36 weeks with RDS was higher than in transient tachypnea subgroup. IL-6 and G-CSF's levels were statistically significantly higher in newborns with congenital pneumonia in comparison with the newborns with noninfectious respiratory diseases.

Conclusions. The laboratorial evaluation of blood cytokines can be useful tool for the differential diagnostics of infectious and non-infectious diseases in the early neonatal period

Congenital heart diseases (CHD) are the largest group of congenital abnormalities, half of which need surgical correction during infancy. Appropriate nutrition is crucial during this sensitive for organ growth period and can be negatively influenced by heart disease. Poor nutrition can be associated with increased perioperative morbidity and mortality.

Aim. The study aimed to analyze nutrition in newborn infants with CHD born and surgically treated in a cardiosurgical perinatal center.

Material and methods. Hospital charts of 23 randomly chosen infants with CHD who had been operated during neonatal period were retrospectively studied. Type, amount, substrate, method as well as energy and macronutrients intake pre- and postoperatively were analyzed.

Results. All infants got enteral feeding before operation. The majority of them received 81-100% of estimated energy on the day preceding the operation. At the same time, six infants (26%) received 51-80%, and two - 50% or less of calculated kcal. There were no cases of necrotizing enterocolitis preoperatively. In the postoperative period enteral feeding was started in the first day in 52% of infants in case of stable hemodynamics, including those receiving inotropes. All infants were fed by formula in the early postoperative period. Cow's milk protein deep hydrolisate was given to those with palliative correction and risk of mesenterial flow compromise, while standart or preterm formula was administered to infants after radical correction. Feeding intolerance was seen in five infants without any association with formula type. Parenteral nutrition was stopped when the enteral load had reached an average of 114 (64-128) kcal/kg/day, and continued for more than 11 days in nine (39%) infants. On the 7^th postoperative day, 80% of the children received more than 80 kcal/kg/day, by 10 days these were all children except for two who were in extremely serious condition. The same trend was noted for protein intake.

Conclusion. A satisfactory level of energy and protein supply in the majority of newborn infants with CHD in perioperative period was achieved by personalized approach to their nutritional support. However, in the early postoperative period, optimization of parenteral nutrition, as well as fortified breast milk and premature formula usage could be potential reserves.

Infectious inflammatory diseases in newborns remain the main cause of the death in neonatal period. They occurred in the setting of the morphofunctional dismaturity of immune system and often paucisymptomatic. The assessment of the specific biomarkers for non-invasive diagnostics and treatment of these diseases is currently important. One of the key regulators of the body system is small non-coding RNAs. miRNAs used for non-invasive diagnostics of a wide range of diseases.

Aim: analysis of the expression level of miRNAs that potentially regulates translation of IL-1β, IL-6, IL-8, IL10, IL13, TNF-α, IFNγ, CCL2 in the peripheral blood plasma of newborns. Newborns of the first day of life with the different gestational ages with respiratory disorders by infectious and non-infectious nature were evaluated.

Material and methods. Real-time RT-PCR was used to quantify hsa-miR-16-5p, -92a-3p, -130a-3p, -223-3p in 81 blood plasma samples of 3 groups of newborns divided by gestational age: 25-28, 29-31 and 32-40 weeks. Serum Plasma kit, miScript® II RT kit, SYBR Green PCR Kit (Qiagen, Germany) were used in the study.

Results. RT-PCR evaluated a significant increase in the expression level of hsa-miR-92a-3p and hsa-miR-130a-3p in the case of diagnosed congenital pneumonia (CP) and early neonatal sepsis (ENS). Statistical analysis revealed a significant correlation between the level of an expression of hsa-miR-16-5p, -92a-3p, -130a-3p, -223-3p and CP; hsa-miR-16-5p, -92a-3p and ENS; hsa-miR-92a-3p and NEOMOD score's scale. The possibility of differential diagnosis of CP and ENS by the expression level of hsa-miR-16-5p and hsa-miR-130a-3p in blood plasma was demonstrated for the group of newborns of 25-31 GA. Statistic significant Spearman correlation were found for CP or ENS. These findings related between the level of hsa-miR-16-5p expression in intraventricular hemorrhage (IVH) and Silverman Score for study groups.

Conclusions. For the first time, the significant changes in the expression level of hsa-miR-16-5p, -92a-3p, -130a-3p, -223-3p in the blood plasma of newborns of various gestational age were demonstrated. We suspected that these findings will use as important tool for the differential diagnosis of CP, ENS and IVH. The miRNA expression level detection in the blood plasma of newborns can allow for more accurate and early diagnosis of infectious inflammatory diseases: CP and ENS, especially among extremely preterm newborns.

Composition of human milk provides the standard for the infant nutrition. It includes the bioactive components that safeguard infant growth and development. Human milk is uniquely suited to the human infant as nutritional composition. Nonnutritive bioactive factors can promote survival and healthy development. Milk fat globule membrane (MFGM) is a complex of unique structure that composed primarily from lipids and proteins. They surround milk fat globule, which secreted from the milk producing cells. It is a source of multiple bioactive compounds, including phospholipids, glycolipids, glycoproteins, and carbohydrates. Most of them have an important functional role within the brain and gut. Clinical studies have demonstrated effects of MFGM-derived bioactive components on the brain structure and function, intestinal development and immune defense. MFGM plays a pivotal role in the support of cardiovascular health by modulating cholesterol and fat uptake. MFGM supplementation of infant formula may narrow the gap in cognitive performance and infection rates between breastfed and formula-fed infants. The article is devoted to trials exploring the effects of MFGM supplementation on the diets of infants or children.

Multiple pregnancies with monochorionic twins are actual, but unfavorable issues of modern obstetrics. Severe complication of the monochorial pregnancy is twin-to-twin transfusion syndrome and selective intrauterine growth restriction syndrome of one fetus. Development of syndromes based on the presence of pathological anastomoses in a vascular network of the placenta. Complications developed usually between 15 to 26 weeks of pregnancy with the increasing risk of an adverse outcome up to 90%. The majority of newborns from complicated monochorial pregnancies were born prematurely. Analysis revealed that neonates with selective intrauterine growth restriction syndrome (SIUGR) type I have less impact on the severity of early neonatal period. We hypothesized that it happens due to the less significant discordance among twins in the utero and decreasing severity of the placental insufficiency. Statistically significant difference in outcomes was found between types II and III, but statistically significant correlation between types I and II. The comparison of twins from pregnancies complicated by twin-to-twin transfusion syndrome (TTTS) with or without intrauterine selective laser photocoagulation has shown the difference in the incidence of persistent pulmonary hypertension and the frequency of partial exchange transfusion. Recently published outcomes of patients born with TTTS and SIUGR will need for an additional analysis of nursing and outcomes.

There is a common perception among neonatoLogists that the high osmolality of enteral feeding for preterm infants increases the rate of gastrointestinal dyskinesia and necrotizing enterocolitis. This suggestion comes from two old studies published in 1975 (Book and SantuLLi). The studies outcomes have been widely quoted since the 1970s aLthough the osmoLaLity of study products exceeded 500 mOsm/kg. PresentLy, there is no any avaiLabLe preterm formuLaе or human miLk fortifiers with such a high osmoLaLity on the market. The anaLysis of recent pubLications on enteraL feeding osmoLaLity and their Link with toLerance and necrotizing enterocoLitis has been performed. Based on reviewed Literature, we have found no evidence for a causaL reLationship between hyperosmoLaLity of feeds and the deveLopment of feeding intoLerance or necrotizing enterocoLitis. At the present time, the safe enteraL feeding osmoLaLity range is LikeLy to be 300-450 mOsm/kg.

Background. Intestinal CMV infection in infants can be associated with watery diarrhea or neonatal necrotizing enterocolitis (NEC).

Case presentations. Two term infants have had severe watery diarrhea and bloody stool. One of them had NEC additionally. Patients were treated with Ganciclovir, specific intravenous immunoglobulin and completely recovered. In the last case, we considered about CMV and gut malformation as a concomitant disease.

Conclusions. Primary CMV infection occurs accompanied with severe complications. Emergency treatment with Ganciclovir should be considered as a first choice treatment in severe cases.

One of the major challenges of neonatal intensive care is the early detection and management of circulatory failure. Routine clinical assessment of the hemodynamic status of newborn infants is subjective and inaccurate, emphasizing the need for objective monitoring tools. An overview will be provided about the use of neonatolo-gist-performed echocardiography (NPE) to assess cardiovascular compromise and guide hemodynamic management. Different techniques of central blood flow measurement, such as left and right ventricular output, superior vena cava flow, and descending aortic flow are reviewed focusing on methodology, validation, and available reference values. Recommendations are provided for individualized hemodynamic management guided by NPE.