Perinatal risk factors affecting the results of nursing premature infants from multiple monochorionic pregnancy
The problem of multiple pregnancy remains to be one of the most urgent in modern obstetrics due to the steady increase in its frequency and numerous perinatal complications. The most severe complications of monochorionic pregnancy are fetal transfusion syndrome (FFTS) and selective single fetal intrauterine growth restriction syndrome (IUGR). A large proportion of neonates from complicated monochorionic pregnancies are preterm infants. In premature twins born as a result of monochorionic pregnancy, the risk of severe perinatal complications is significantly higher than in children of the same gestational age born from single and dichorionic pregnancy. In this study, we have tried to identify perinatal risk factors affecting the results of nursing premature infants from multiple monochorionic pregnancies. The most severe group, as expected, were patients with FFTS, they had not only the highest mortality rate, but also a high incidence of severe, disabling complications. Within the group, the ratio of adverse outcomes among donors and recipients was 2:1. In the group of patients with CVD mortality was 1.6 higher than among premature infants born from single and dichorionic pregnancy. Our study once again confirmed that children from all multiple monochorionic pregnancies have a high risk of perinatal factors adversely affecting the outcome.
Efficiency of implementation of Local guideline of preterm newborns stabilization in delivery room, which includes sustained inflation of lung by indications followed by CPAP
Aim - to evaluate the efficiency and results of implementation of the guideline of stabilization of premature newborns with sustained inflation followed by CPAP in delivery room.
Material and methods. Cohort retrospective trial. 341 premature newborns, borne in V.I. Kulakov Obstetrics, Gynecology and Perinatology National Medical Research Center of Ministry of Healthсаre of the Russian Federation were included in the period from 2013 to 2015 yrs were included. Newborns were divided into 2 groups: before new protocol was implemented (2013 year - 116 newborns) and after (2014-2015 yrs - 225 newborns). Mechanical ventilation in delivery room and in 48 hours of life, surfactant therapy, IVH, BPD, pneumothorax, survival rates were compared and assessed between two groups.
Results. Mechanical ventilation requirement in delivery room and in NICU in first 48 hours of life was in two time less after new protocol was implemented OR [95% CI] 0.53 [0.29; 0.95], p=0.032, and 0.52 [0.28; 0.99], р=0.047 respectively. Severe IVH, BPD, pneumothorax incidents did not increased after new protocol was implemented: 2.2, 5.8, 2.7% vs 6.9, 3.4, 6% respectively. New protocol implementation was associated with increasing of survival rates from 89 to 96% р=0.021 and decreasing of PDA incidents from 44.8 to 16.9% р<0.0001.
Conclusion. The implementation of new protocol of stabilization of premature babies in delivery room, which includes sustained inflation approach followed by CPAP is associated with reduction of mechanical ventilation requirement, and does not affect adverse outcomes.
Wolman disease is a severe infant form of lysosomal acid lipase deficiency
The article presents a rare, rapidly progressing disease, timely diagnosis and specific therapy of which is highly effective and, currently, available in Russian Federation. Based on a literature review, the article highlights the prevalence, clinical features of the course, modern methods of diagnosis based on the determination of the activity of the enzyme lysosomal acid lipase in dry blood spots, and treatment. Deficiency of lysosomal acid lipase is a rare hereditary disease, based on impaired metabolism of esterified cholesterol and triglycerides and their subsequent accumulation in the lysosomes of cells. Currently, there are an early onset or severe infant form, historically called Wolman disease with manifestation in first weeks of life in form of vomiting, diarrhea, loss of body weight in combination with hepatomegaly, and a variant of late onset of the disease that starts in older children or in adults and presented with dyslipidemia, early atherosclerosis, hepatosplenomegaly, fibrosis or cirrhosis of the liver.
Clinic case of severe methemoglobinemia in premature infant
There is a case report of methemoglobinemia in preterm infant. The diagnosis was proved by specific laboratory test of blood samples. The review of actual literature data about pathogenesis, classification and peculiarities of clinical features, diagnostics and therapy of methemoglobinemia was carried out.
Thrombolytic therapy in the newborn with massive arteriovenous thrombosis. Experience of the Morozov Children's City Clinical Hospital
Systemic thrombosis is a rare condition in neonatal practice, can Lead to disability and even death, and require immediate diagnosis and intensive care. At the moment, in the world practice there is not enough experience in conducting systemic thrombolytic therapy in newborns. Therefore, each such case is approached individually, guided by the available experience and equipment.
In this article we would like to share the experience of thrombolytic therapy in the newborn admitted to the intensive care unit for newborns of Morozov children's city clinical hospital at the age of 7 days of life. Diagnosis on admission: "acute occlusive thrombosis of the abdominal aorta, both common iliac arteries. Thrombosis of the upper sagittal sinus of the brain". The child underwent systemic thrombolytic therapy with a positive effect. At the age of 1 month of life he was discharged from the hospital in a satisfactory condition.
Epidemiological safety of neonates entreal feediing in neonatal units
This publication provides a description of the main manipulations, technologies to ensure their epidemiological safety in organizing enteral feeding of newborns and premature babies, which can be used to develop standard operating procedures and checklists for internal audit. In the development of the presented recommendations, the most experienced specialists from the National Association of Specialists on Control of Infections Related to Medical Care and Russian Society of Neonatologists were involved.
Boundaries of private life, or Physicians are people too (and a little more about the Hippocratic oath). Part one
The article describes protection of medical professionals privacy; moral issues related to professional attributes of neonatoLogists; possibilities of protection of honour, dignity and good standing in social networks, Internet Network, mass communication; bringing to civil, administrative and criminal responsibility for insulting, slander and illegal distribution of personal data.
Early inflammatory markers for the diagnosis of late-onset sepsis in neonates: The Nosodiag Study
Background. Early diagnosis is essential to improve the treatment and prognosis of newborn infants with nosocomial bacterial infections. Although cytokines and procalcitonin (PCT) have been evaluated as early inflammatory markers, their diagnostic properties have rarely been compared.
Objectives. This study evaluated and compared the ability of individual inflammatory markers available for clinician (PCT, semi-quantitative determination of IL-8) and of combinations of markers (CRPi plus IL-6 or quantitative or semi-quantitative determination of IL-8) to diagnose bacterial nosocomial infections in neonates.
Methods. This prospective two-center study included neonates suspected of nosocomial infections from September 2008 to January 2012. Inflammatory markers were measured initially upon suspicion of nosocomial infection, and CRP was again measured 12-24 h later. Newborns were retrospectively classified into two groups: those who were infected (certainly or probably) and uninfected (certainly or probably).
Results. The study included 130 infants of median gestational age 28 weeks (range, 24-41 weeks). Of these, 34 were classified as infected and 96 as uninfected. The sensitivity, specificity, positive and negative predictive values (PPV and NPV), and positive and negative likelihood ratios (LR+ and LR-) for PCT were 59.3% (95% confidence interval [CI], 38.8-77.6%), 78.5% (95% CI 67.8-86.9%), 48.5% (95% CI 30.8-66.5%), 84.9% (95% CI 74.6-92.2%), 2.7 (95% CI 1.6-4.9), and 0.5 (95% CI 0.3-0.8), respectively. Semi-quantitative IL-8 had the highest specificity (92.19%; 95% CI 82.70-97.41%), PPV (72.22%; 95% CI 46.52-90.30%) and LR+ (6.17, 95% CI 2.67-28.44), but had low specificity (48.15%; 95% CI 28.67-68.05%). Of all markers tested, the combination of IL-6 and CRPi had the highest sensitivity (78.12%; 95% CI 60.03-90.72%), NPV (91.3%; 95% CI 82.38-96.32%) and LR- (0.29; 95% CI 0.12-0.49). The combination of IL-6 and CRPi had a higher area under the curve than PCT, but with borderline significance (p=0.055).
Conclusion. The combination of IL-6 and CRPi was superior to other methods, including PCT, for the early diagnosis of nosocomial infection in neonates, but was not sufficient for sole use. The semi-quantitative determination of IL-8 had good diagnostic properties but its sensitivity was too low for use in clinical practice.
A pathogenic relationship of bronchopulmonary dysplasia and retinopathy of prematurity? A review of angiogenic mediators in both diseases
Bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) are common and significant morbidities of prematurely born infants. These diseases have in common altered and pathologic vascular formation in the face of incomplete organ development. Therefore, it is reasonable to question whether factors affecting angiogenesis could have a joint pathogenic role for both diseases. Inhibition or induced expression of a single angiogenic factor is unlikely to be 100% causative or protective of either of BPD or ROP. It is more likely that interactions of multiple factors leading to disordered angiogenesis are present, increasing the likelihood of common pathways in both diseases. This review explores this possibility by assessing the evidence showing involvement of specific angiogenic factors in the vascular development and maldevelopment in each disease. Theoretical interactions of specific factors mutually contributing to BPD and ROP are proposed and, where possible, a timeline of the proposed relationships between BPD and ROP is developed. It is hoped that future research will be inspired by the theories put forth in this review to enhance the understanding of the pathogenesis in both diseases.