The improvement of the hyperglycemia treatment in premature newborns
There are two basic approaches for the correction of the hyperglycemia in preterm newborns who received an intravenous glucose infusion. The first option is a decrease of the rate of a glucose intake. This is a shortterm decision, because it leads to the reduction of calories consumption. The second method is insulin therapy, but the early treatment associated with a higher risk of the developing hypoglycemia.
Material and methods. From January 2012 to January 2014, 120 newborns with hyperglycemia have examined in the Neonatal Intensive Care Unit. Hyperglycemia was considered as a 2 times of the blood glucose increasing above >8.0 mmol/l with an interval of 4 hours. Retrospectively the children were divided into 3 groups: 1st group - hyperglycemia, treated with a decreasing rate of the glucose intake (n=40), 2nd group - treatment of hyperglycemia, with a reducing of the glucose intake followed by insulin therapy (n=23), 3rd group - insulin therapy treating hyperglycemia (n=6). Groups were divided into sub groups by gestational age: 23-27 GA weeks, 28-29 GA weeks, 30-31 GA weeks and 32-33 GA weeks.
Results and discussion. In the neonatal period, transient hyperglycemia develops in 72.5% of children with VLBW and ELBW. Hyperglycemia a high correlated with the gestational age of the newborn. The optimal method for newborn with gestational age ≥28 weeks is decreasing of the rate of a glucose intake. Insulin therapy can recommended when the conservative treatment was insufficient after 5 (4; 9) hours of the observation. Newborns with the gestational age <28 weeks with hyperglycemia recommended to use the insulin therapy as an option of choice.
The role of aggressive factors of respiratory support in the formation of bronchopulmonary dysplasia in preterm infants
Bronchopulmonary dysplasia is a chronic poLyetioLogicaL disease of morphologically and functionally immature Lungs, most common in premature infants who require respiratory support and oxygen therapy to relieve acute respiratory failure. The most important risk factors for this disease are aggressive factors of respiratory therapy, which have a direct damaging effect on the structure of the bronchopulmonary system.
Aim of research - to evaluate the role of respiratory therapy factors in the formation of bronchopulmonary dysplasia in preterm infants with very low and extremely low birth weight.
Material and methods. The study included 97 premature newborns with a gestation age <32 weeks, a birth weight <1500 g, with respiratory disorders and requiring respiratory therapy. Depending on the outcome of respiratory pathology, newborns were divided into 2 groups: 1st group - children who formed bronchopulmonary dysplasia (n=50), 2nd group - children who recovered from respiratory pathology (n=47).
Results and discussion. It was found, that the mask and endotracheal ventilation in the delivery room increase the risk of bronchopulmonary dysplasia. Children of 1st group compared with 2nd group, significantly more often required endotracheal [64.0 and 31.9% respectively, p=0.001; OR=3.793 (CI 1.633-8.806)] and mask ventilation [74.0 and 40.4% respectively, p=0.001; OR=4.194 (CI 1.776-9.906)]. It was found, that the use of supplement oxygen in the delivery room was significantly more often noted in the 1st group of newborns in comparison with recovered children [96.0 and 44.7% respectively, p=0.001; OR=29.71 (CI 6.455-136.8)]. The complex of prolonged respiratory therapy, including endotracheal ventilation, non-invasive ventilation and oxygen therapy was required in 56.0% of patients from 1st group and in 25.5% of cases in the 2nd group [p=0.002; OR=3.712 (CI 1.546-8.783)]. The maximum value of mean airway pressure, expiratory tidal volume, fraction of oxygen and total duration of their exposure, were significantly higher in 1st group compared to 2nd group (p=0.001). The use of non-synchronized algorithms of endotracheal respiratory support was significantly more frequently recorded in patients from 1st group compared with children from 2nd group [42.1 and 14.3% respectively, p=0.026; OR=4.367 (CI 1.096-17.370)].
Summary. Aggressive factors of respiratory therapy, contributing to the formation of bronchopulmonary dysplasia in newborns with very low and extremely low birth weight, are: endotracheal and mask ventilation in delivery room, long-term use of endotracheal ventilation in combination with non-invasive ventilation and oxygen therapy, high values of mean airway pressure, tidal volume expiratory and fraction of oxygen, application of non-synchronized algorithms of endotracheal respiratory support.
The long-term consequences of prematurity - the metabolic syndrome in children and adolescents: is there a risk?
Aim - to assess the burden of family history of metabolic syndromecomponents and prematurity, and the presence of metabolic syndromecomponents in children and adolescents born prematurely.
Material and methods. The study involved 123 people born during the period 1997-2008. 58 children born prematurely, age (12±1.3) years, gestation period (33.07±1.9) weeks (main group). The control group comprised 65 full-term peers, age (12.7±2.2) years, duration of gestation (39.5±0.8) weeks. Participants were evaluated for PD (height, weight, body mass index (BMI), waist circumference (OT), hip circumference (OB)) in the WHO AnthroPlus program, MS Components, assessed according to the recommendations of the International Diabetes Federation (IDF).
Results. In the main group, cases of preterm labor were 44.8% versus 3.07% in the control group (p<0.0001). In mothers of the main group AH was registered in 27.6% against 4.6% in the control group (p=0.002). In grandmothers, the mother in the main group AH: 69%, compared with 10.8% in the control group (p<0.0001). Mothers of premature babies were more likely to suffer from obesty: 29.3% versus 9.2% in mothers of the term infants (p=0.008). Obesity at grandmothers on a line of mother in the basic group was registered 44.8%, in group of the control - 10.8% (p<0.0001). Overweight of 31% in the main group and 9.2% in the control group (p=0.002). Abdominal type of fat release (R/OB>0.8) had 21 people, in the control group 4 (p<0.0001). From >90 percentile had 5.2% of preterm. The Z-score of BMI in boys and girls, WC/TC higher in the main group than in the control group (p=0.04, p=0.01, p<0.0001) respectively. In preterm girls of pubertal age, the level of LDL and IA is higher than in term donors (p=0.04) and (p=0.02), respectively. Weight, height, z-score of growth, WC, TC, BMI in them are interrelated with the level of TAG in the serum of preterm girls, p=0.002; p=0.03; p=0.03; p=0.005; p<0.0001; p=0.02, respectively. AH as a component of MS was registered in 37.9% in the main group, in the control group in 1.5% (p<0.0001). Normal blood pressure was 51.7% of the main group, in the control group 89.2% (p<0.0001). AH among children and adolescents born prematurely 34.5%, in the group of healthy peers 1.5% (p<0.0001). In preterm girls, the blood pressure level is associated with the Tyg index (p=0.004).
Conclusion. The anamnesis of premature infants and adolescents is highly burdensome in terms of prematurity and MS components. Abdominal type of fat deposits along with excess body weight are more common in the cohort of prematurity. The level of fasting glycaemia and lipidogram indices did not have significant deviations from the norm in the general sample, however, preterm girls of the pubertal period showed an increase in the level of low-density lipoproteins and a high degree of association of physical development (PD) indices with the level of TAG. About 40% of children and adolescents born prematurely have BP >90 percentile, and a little less registered arterial hypertension I degree. The level of blood pressure in preterm girls is associated with the Tyg index, and the PD indices are associated with the TAG level.
Dynamics of cardiorespiratory and echocardiographic parametres in infants with bronchopulmonary diplasia
Premature infants with bronchopulmonary dysplasia (BPD) need cardiorespiratory monitoring during the first year of life, since longer apnea persistence may have negative effect on the course of the disease. Dynamics of echocardiography parameters is also very important because there is a tendency to pulmonary artery pressure increase, which can lead to pulmonary hypertension (PH).
The aim of the study was to evaluate the dynamics of cardiorespiratory and echocardiography parameters in premature infants with BPD.
Material and methods. Cardiorespiratory monitoring and echocardiography were performed in 11 infants born at 24 0/7-29 0/7 weeks gestation, with birth weight <1400 grams and had BPD, at two age periods: at 35-41 weeks of postmenstrual age (PMA) before discharge from the hospital and at 9-10 corrected months of life (71-87 weeks of PMA). Of them three infants were diagnosed PH.
Results. The average SpO2 was satisfactory at both age periods. Desaturation index, number of desaturation episodes <10% were decreased in secondary examination. There was a strong tendency to apnea/hypopnea index decrease. We did not find difference in indexes of each type of apnea between these age periods. There was a significant decrease in the mean pulmonary artery pressure, the absence of regurgitation and hemodynamic overload of right ventricle at the second echocardiography. In our study, any infants did not have the right atrium dilation and flattening of the interventricular septum. There was also no association between the occurrence of obstructive apnea and increase in mean pulmonary artery pressure.
Conclusions. The positive dynamics of cardiorespiratory and echocardiographic indices in infants in 9-10 corrected months of life was marked.
The influence of inspiratory time on the efficiency of non-invasive ventilation in preterm infants
It remains unclear whether non-invasive ventilation is more effective than nasal CPAP in premature infants. Short inspiratory time can lead to ineffectiveness of non-invasive ventilation when device with open exhalation circuit such as Infant Flow SiPAP is used in BiPhasic mode. Optimal inspiratory time could compensate circuit leakage and improve the efficiency of non-invasive ventilation.
Aim - to compare three modes of non-invasive respiratory support of Infant Flow SiPAP to define whether inspiratory time influences on the efficiency of non-invasive ventilation in preterm infants.
Material and methods. Prospective comparative trial. 298 premature babies born at 28-35 weeks were included. After initial stabilization on CPAP in delivery room, they were randomized immediately after admission to NICU and divided into 3 groups. 97 newborns formed 1st group where BiPhasic mode with insp.time 1.0 sec and frequency 30 per minute. 86 newborns formed 2nd group BiPhasic mode with insp. time 0.5 second and frequency 60 per minute. Group 3 included 115 premature babies on CPAP mode. Mean airway pressure was similar on BiPhasic groups (1st and 2nd). Incidents of non-invasive support failure in groups was evaluated. The failure criteria were the increase of FiO2 >0.4 (FiO2 >0.3 for babies <1000 g) and/or increasing of severe respiratory distress, hard work of breathing equivalent to 4 and more points by Silverman scale. In case of start respiratory support, failure babies were switched to higher level of respiratory support.
Results. In 1st group, where the respiratory therapy was provided by BiPhasic mode with Tin of 1.0 second, the failure was 2 times less than in 2nd group and 3rd group: 33% vs 65% vs 62% (p=0.00003). Respiratory support failures in 2nd and 3rdgroup were similar.
Conclusion. Infant Flow SiPAP on BiPhasic mode has advantage over CPAP when inspiratory time is 1.0 second to compensate the leakage and create an optimal peak inspiratory pressure. BiPhasic mode with inspiratory time 0.5 sec has the same efficiency as CPAP mode and has no advantages over CPAP.
Concentration of serum procalcitonin as a criterion of antibacterial therapy refuse in groups of late
The article presents a review of studies on the evaluation of the effectiveness of antibiotic therapy in newborns with sepsis based on a measurement of procalcitonin concentration in the blood plasma. The urgency of the problem under consideration is undoubted, because at present time there is no reliable and highly sensitive marker reflecting the nature of the course of the infectious process and allowing to take a timely and justified decision to discontinue antibiotic therapy. There are only a few works indicating the possibility of applying the analysis of procalcitonin concentration in plasma in order to make a rational decision on further antimicrobial therapy. It has been established that using the procalcitonin test in newborns with suspected sepsis can significantly reduce both the duration of antibiotic therapy and inpatient treatment. A representative sample of newborns with proven sepsis and septic shock could give an opportunity to demonstrate effectiveness of the procalcitonin test for the purpose of correcting therapy. The absence of such a sample in all the studies presented should be noted as a significant drawback.
Fatty acids as part of lipid emulsions for parenteral nutrition in neonatology
Fatty acids are one of the most important part of neonatal nutrition. If we cannot use enteral feeding to donate them, parenteral nutrition is the option. One of the most important part of parenteral nutrition is lipid emulsions. It is important to know how they impact on energy and plastic metabolism, immune system etc. to choose type of lipid emulsions correctly. This literature review has data about the most important fatty acids what can help us to choose correct type of lipid emulsions for newborn parenteral nutrition.
Application of intravenous medium-length (midline) catheters in neonatal intensive care department
A Large number of newborns receive medical care and handling in the Neonatal Intensive Care Units (NICUs) worldwide annually. A comprehensive treatment, including fluid resuscitation and intravenous introduction of medications, is administered to NICU patients of various gestational age. Umbilical venous catheters, short peripherally placed intravenous (IV) catheters, medium-length (midline) catheters, central venous catheters, peripherally inserted central catheters, tunneled central venous catheters are used to ensure neonatal vascular access. The most commonly used catheters in NICU are short peripherally placed intravenous catheters, peripherally inserted central catheters and central venous catheters. Recently the interest in conducting fluid resuscitation and introduction of medications via medium-length peripheral venous catheters has been restored in the world. Widespread usage of midline catheters in adult patients, as well as in newborns, is due to a number of important practical advantages (easy to insert, no need for mandatory radiological (X-ray) control and monitoring of the location of the catheter tip, longer indwelling time of the midline catheter compared to short peripherally placed intravenous catheters). Midline catheters promote reduction of the number of manipulations, painful procedures and risk of various complications. Ultimately, this leads to improvement of the patient's condition, acceleration of recovery and handling of newborns (including extremely low birth weight infants) and discharge from the hospital.
Maintaining normothermia: Why and how?
A high incidence of postnatal hypothermia has been reported in high-as well low-resource countries and it remains an independent predictor of neonatal morbidity and mortality, especially in very preterm infants in all settings. The temperature of newly born infants should be maintained between 36.5 and 37.5 °C after birth through admission and stabilization. Interventions to achieve this may include environmental temperature 23-25 °C, use of radiant warmers, exothermic mattresses, woollen or plastic caps, plastic wraps, humidified and heated gases. Skin-to-skin contact has been used, especially in low-resource settings. The combinations of these interventions applied to quality improvement initiatives, including staff training, use of checklists, and continuous feedback with the staff involved in the management of the neonate, are key factors to prevent heat loss from delivery room to admission to the neonatal intensive care unit. The admission temperature should be recorded as a predictor of outcomes as well as a quality indicator.