Improving of nursing care and methods of abilitation for extremely low body weight infants: critical evaluation of the contribution of Russian scientists
Effective nursing and successful abilitation of extremely low birth weight (ELBW) preterm infants is a complicated medical problem, solution of which is largely owing to improvement of scientific knowledge.
The aims of the work was to find Russian scientific articles which are devoted to the problems of extremely low body weight infants nursing, as well as to study their citation level in national and international databases.
Material and methods. The request was conducted in the Russian-language search system eLIBRARY.RU and in the English-language search system PubMed.
Results. The survey results demonstrate a very modest (0.41%) contribution of Russian researchers to solving the problem at the international level. As for citation, not a single article in Russian published after 2015 was cited more than 7 times.
Discussion. The obtained data reveal a decrease both in level of interests of researches towards the Russian experience of effective nursing of ELBW preterm infants, and in number of domestic studies in domain of discourse.
Conclusion. Fixation on studying only foreign experience poses the risk of further incomplete adaptation of advanced medical technologies to modern realities of Russian Healthcare Service. Reduction in a number of national scientific researches aimed at improving medical care for ELBW preterm infants threatens to turn Russian neonatology from the forefront of Russian pediatric science into stagnating branch of medicine.
Regional experience in the formation of professional competencies in the medical team to provide emergency medical care to a newborn - a strategy and tactics in reducing the infant mortality rate
The mortality rate of infants in the Khabarovsk Region was steadily decreased over the past 10 years. It was reduced from 2012 to 2018 more than 2 times and reached a historical minimum of 5.0 per 1.000 live births. The provision of specialized medical care had certain difficulties and especially in areas with low population density and limited medical infrastructure. Therefore, it will be necessary to find ways for cooperation and teamwork. The approach for the formation of competencies in the nursing team, the development of team skills and implementation of monitoring of the basic professional competencies for neonatal resuscitation has an on influence on significant health indicators. The modern innovations in organization, methodology, and education resulted in the decreased of the early neonatal and infant mortality in the Khabarovsk Region.
Respiratory distress syndrome as a cause of early neonatal mortality (according to the Russian Federal State Statistics Service in 2013-2017)
The results of the analysis of Rosstat data for 2013-2017 about early neonatal death due to respiratory distress syndrome (RDS) are presented. According to Rosstat for 2013-2017, the share of RDS among all cases of early neonatal death was 18.4%. The frequency of Lethal forms of RDS differs in various federal districts of the Russian Federation. The highest values of the RDS specific share in early neonatal death were recorded in the Far Eastern and Ural Federal districts (27.1 and 24.5%, respectively). The share of RDS in the structure of the causes of early neonatal death in newborns in rural areas exceeded that in urban areas. Hypertensive diseases of a pregnant woman, as well as premature rupture of amniotic fluid, premature placental abruption and placental insufficiency were more common among the conditions that caused the death of newborns from RDS. Antenatal prevention of RDS and timely therapy of the newborn are considered the main way to reduce deaths from RDS.
Frequency, risk factors, features of bronchial asthma in children with bronchopulmonary dysplasia and management of comorbid patients
Bronchopulmonary dysplasia (BPD) and bronchial asthma (BA) are the most common chronic lung diseases in children, but the relationship between these diseases has not been fully defined. The incidence of atopic diseases (atopic dermatitis, allergic rhinitis, and BA) in children with BPD are significantly different according to national and international studies. There is not enough data on risk factors for the development, clinical and laboratory features of the course and treatment of BA in children with BPD.
Material and methods. The case histories of 1104 patients (2004-2017) with BPD criteria were analyzed at the Department of Pediatrics at the RUDN University. On the basis of clinical and anamnestic data, allergological examination, and study of respiratory function, the frequency of asthma was determined. The comparative study was conducted in patients with isolated diseases - BPD (without BA) and BA (without BPD) - to determine the risk factors and characteristics of BA in children with BPD.
Results and discussion. The frequency of BA was 7%, atopic dermatitis - 3.8% and allergic rhinitis - 3.6%. The risk factors for the development of BA in children with BPD were determined for low birth weight (LBW) (p=0.0037), late prematurity (p=0.0007), family history of allergy through asthma (p=0.0334), concomitant atopic dermatitis (p=0.0018) and allergic rhinitis (p=0.0022). Severe BPD (p=0.0002), episodes of bronchial obstruction in the first 3 years of life (p=0.0272). It was found that BA in children with BPD, compared with children without BPD is statistically significant. It characterized by an earlier onset (p=0.0168), a mild intermittent course (p=0.0003), a rarer need for inhaled bronchodilators (p=0.0034) and more frequent administration of inhaled corticosteroids as basic therapy (p=0.0399).
Conclusion. We suggested that BA in children could be a respiratory consequence of BPD and a comorbid disease with a separate phenotype. The management of children suffering from BA and BPD should include the registration and evaluation of epidemiology, risk factors, clinical and laboratory features. It would be necessary to implement the clinical and allergological examination and the development of an individualized management program for patients.
Experience in continuous peritoneal lavage in the extremely low body weight infant
The article presented the comparative characteristics of methods of kidney replacement therapy in newborns. We present the clinical case of continuous flow peritoneal dialysis in a newborn with extremely low birth weight (660 g birth weight) with acute renal injury.
Overview of the European consensus guidelines on the management of respiratory distress syndrome – 2019
Up-dated European consensus guidelines on the management of respiratory distress syndrome in newborns were published in April 2019. We present the translation of these clinical guidelines. The review focused on the key factors as monitoring of the pregnancy, stabilization of a newborn in the delivery room, oxygen supplementation, and stabilization of the blood pressure. Surfactant therapy, non-invasive respiratory support, strategies for protective endotracheal ventilation, and usage of steroids in the postnatal period were discussed. The particular attention was paid to the main changes in the new version of recommendations and advanced directions in the diagnosis and treatment of respiratory distress syndrome. Comparative analysis with available the Russian National Clinical Guidelines (2016) was performed.
Homeostasis of minerals and trace elements in newborns. Part 1. Distribution of magnesium in the body
The review highlights the key aspects relating to magnesium homeostasis. It physicochemical state and biological role in the body, content, distribution in body fluids, and various tissues as blood, urine, hair, placenta, spleen, and kidney. Magnesium homeostasis is an area of special interest, but recent research results in perinatal medicine are very poor. Special attention was focused on the methods of assessment of magnesium concentrations in the body and units of measurement. Moreover, we made the accent on the practical importance of scientific data in the functional system «mother-placenta-fetus-newborn».
Boundaries of private life, or Physicians are people too (and a little more about the Hippocratic oath). Part 2
In the article about bringing to general, administrative and criminal Liability for offence and slander, illegal trafficking of personal data, for publications in mass communications damaging honor and dignity, Internet Network and social networking sites is related.
Evidence-based skin care in preterm infants
Most guidelines on neonatal skin care emphasize issues pertaining to healthy, term infants. Few address the complex task of skin barrier maintenance in preterm, very preterm, and extremely preterm infants. Here, we provide an evidence-based review of the literature on skin care of preterm neonates. Interestingly, the stratum corneum does not fully develop until late in the third trimester, and as such, the barrier function of preterm skin is significantly compromised. Numerous interventions are available to augment the weak skin barrier of neonates. Plastic wraps reduce the incidence of hypothermia while semipermeable and transparent adhesive dressings improve skin quality and decrease the incidence of electrolyte abnormalities. Tub bathing causes less body temperature variability than sponge bathing and can be performed as infrequently as once every four days without increasing bacterial colonization of the skin. Topical emollients, particularly sunflower seed oil, appear to reduce the incidence of skin infections in premature neonates - but only in developing countries. In developed countries, studies indicate that topical petrolatum ointment increases the risk of candidemia and coagulase-negative Staphylococcus infection in the preterm population, perhaps by creating a milieu similar to occlusive dressings. For preterm infants with catheters, povidone-iodine and chlorhexidine are comparably effective at preventing catheter colonization. Further studies are necessary to examine the safety and efficacy of various skin care interventions in premature infants with an emphasis placed on subclassifying the patient population. In the interim, it may be beneficial to develop guidelines based on the current body of evidence.
Prospective study of pulmonary hypertension in preterm infants with bronchopulmonary dysplasia
Aim. To evaluate the prevalence, risk factors, and optimal timing of echocardiogram for pulmonary hypertension (PH) in infants with bronchopulmonary dysplasia (BPD).
Design. In this prospective study, infants with gestational age (GA) <30 weeks admitted to a tertiary NICU between July 2015 and June 2017 who required positive pressure ventilation or oxygen therapy at ≥28 days of life were evaluated with serial echocardiograms at study enrollment (4-6 weeks of age), 32 weeks (only for ≤25 weeks), 36, and 40 weeks post-menstrual age (PMA) for PH.
Results. Of 126 infants (mean birth weight 858±221 g; mean GA 26.1±1.6 wks), 48 (38%) developed PH at any time during their hospital stay. The first study echocardiogram was performed at a median age of 31 weeks PMA. The prevalence of PH was 36/126 (28.5%) at enrollment, at 6/30 (20%) at 32 weeks, 24/111 (21.6%) at 36 weeks, and 10/ 59 (17%) at 40 weeks. No new cases of PH were identified at 40 weeks. At 36 weeks, none of the infants with mild BPD had PH, whereas 20% of moderate and 32% of severe BPD infants had PH. After controlling for confounding variables severe BPD (OR 3.31, 95% CI 1.12, 9.74), and ventilator associated pneumonia (OR 17.9, 95% CI 3.9, 82.11) remained independent risk factors for BPD-associated PH.
Conclusion. Echocardiographic screening for PH can be safely restricted to infants with moderate or severe BPD at 36 weeks PMA. We identified ventilator associated pneumonia as an independent risk factor for PH.