The difficulty in diagnosing acute kidney injury (AKI) in premature infants is due to the absence of specific symptoms of AKI, the presence of a nonoliguric AKI variant, and the lack of a common understanding of the normal concentration of serum creatinine depending on gestational and postnatal age.

The aim was to determine the frequency and clinical features of AKI in premature infants.

Material and methods. A retrospective and observational prospective study was carried out, which included clinical, laboratory and ultrasound examination of premature infants born at the National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov (Center). The retrospective study included 459 preterm infants born at the Center in 2018 and admitted to the ICU from the maternity back. The prospective study included 80 preterm infants who needed treatment in the ICU. The children were divided into 2 groups. Group 1 included 60 premature babies without AKI, group 2 - 20 premature babies with AKI. The groups were comparable for birth weight and gestational age.

Results. The incidence of AKI in premature infants treated in the ICU was 6.5%. The incidence of AKI increased with decreasing gestational age and was the highest (71%) in the group of children with gestational age less than 28 weeks. Among the forms of AKI, there was an early form (60%) and a late form (40%). It was noted that the development of AKI significantly increased the risk of a poor prognosis. Among children who had such a complication as AKI, death occurred in 36.7%. Grade 2-3 intraventricular hemorrhages and periventricular leukomalacia were 6 times more common in children with AKI. The presence of fetal transfusion syndrome in multiple pregnancies increased the risk of AKI by 3.27 times (95% CI 0.98-10.93). Among diseases and conditions of the early neonatal period, congenital pneumonia (p=0.004), circulatory failure (p<0.001) and hemodynamically significant functioning ductus arteriosus (p=0.046) were significant for the development of AKI. In children who required high frequency mechanical ventilation, traditional mechanical ventilation and cardiotonic therapy in the early neonatal period, AKI developed much more often (p<0.001). The use of nephrotoxic drugs (Gentamicin and Vancomycin) was significantly more common in the group of children with AKI; the majority had their consistent appointment: 17 (85%) vs 30 (50%) (p=0.045).

Conclusion. The factors that increased the risk of AKI in preterm infants include: congenital pneumonia, hemodynamically significant patent ductus arteriosus, impaired central hemodynamics, respiratory and cardiovascular insufficiency, requiring mechanical ventilation and cardiotonic therapy, as well as the use of nephrotoxic drugs. AKI in premature infants is characterized by the presence of early and late forms, oliguric and non-oliguric variants. Grade 2-3 intraventricular hemorrhage and periventricular leukomalacia are diseases that are often (in 45%) associated with AKI in a premature baby.

Objective. To analyze the course of retinopathy of prematurity (RP) in children with extremely low body weight (ELBW) and very low body weight (VLBW) in Mordovia.

Material and methods. A retrospective analysis of 202 patients charts at with gestational age 20-32 weeks, born in 2014-2020, was carried out at the Mordovia Regional Clinical Hospital of Mordovia (Saransk). Children with retinopathy of prematurity (ROP) were divided into two groups: the main group, divided into two subgroups: the 1^st - premature babies with ELBW (n=39) and the 2^nd - children with VLBW (n=63). And the control group (premature babies without retinopathy), also divided into two subgroups: ELBW (n=25) and VLBW (n=75). The results were processed using the statistical program Statistica 10.0.

Results. Children with ELBW with retinopathy in 100% of cases were born at a term of less than 30 weeks. In children with VLBW such children - 76%. In the group of children with ELBW and VLBW with retinopathy, significant factors are chronic placental insufficiency (CRF) (F - 0.95 and 0.92) and a history of miscarriages (F - 0.91 and 0.93). Children with ELBW in both groups quite often received red blood cell transfusions 4 or more times. In both groups of children with ELBW (58.9 and 48%), the patent ductus arteriosus functioned. The duration of respiratory support in children with both ELBW and VLBW in most cases did not exceed 10 days.

Conclusion. Significantly more often children with VLBW in the main group received more than 4 blood transfusions - 33.3% (p<0.05). In children with ELBW, stage II RP was more often observed (59.2%), in children with VLBW - in stage I (66.7%). In children with ELBW in both groups (97.4 and 92%, respectively), prematurity anemia prevailed.

The article presents a modern view on the basic principles of diagnosis and treatment of heart failure in newborns and premature babies. The current criteria for interpretation of results of additional laboratory methods for monitoring the degree of heart failure in newborns (NT-proBNP) are described. The principles and algorithms for the management of newborns and premature infants with heart failure are presented.

Currently, intrauterine transfusion (IUT) is the standard of treatment for severe forms of fetal hemolytic disease (HDF). Owing to this method, in recent years, there has been a significant decrease in the incidence of severe forms of Rh-mediated hemolytic disease of the newborn (HDN). It changes the HDF pathogenesis, allowing the continuation of the pregnancy, and besides this significantly affects the postnatal picture of the disease. In this connection it's necessary to determine the most informative predictors of the intensive postnatal hemolysis which would allow to predict the severity of HDN and choose the optimal neonatal treatment after IUTs. Literature analysis has shown that there are several criteria: antenatal (assessment of antibody cytotoxicity, amount of IUTs, bilirubin level at the last IUTs) and postnatal criteria (fetal hemoglobin fraction, reticulocytes level in peripheral blood, and direct Coombs' test after birth). The most informative and clinically available predictors are the fetal hemoglobin fraction of more than 40-50%, determined by Kleinhower-Betke test or an automatic blood analyzer; the reticulocyte count of >100x10⁹ and a positive direct Coombs' test after birth.

Management of enteral feeding in very preterm infants is extremely challenging for neonatogists. Feeding strategies are fundamental for preventing necrotizing enterocolitis, normal growth and development of preterm infants, including neurodevelopmental outcomes. This review presents current trends and principles of enteral nutrition of preterm infants.

The article presents the guideline of management of the newborns with congenital anemia due the fetal blood loss: definition, etiology, diagnostics and treatment of this disease with evidence based practice, algorithm of management and health care quality criteria.

The article discusses the new provisions of Legislation on the issuance of medical documents on birth and death in connection with the already existing regulatory Legal acts on the criteria of Live birth, on acts of civil status and on the regulatory regulation of the issuance of bodies of the deceased for burial.

Hemodynamic compromise of the neonate can occur in various clinical situations, including but not limited to maladaptation during the early transitional period, sepsis, congenital heart anomalies, hemodynamically significant patent ductus arteriosus, persistent pulmonary hypertension of the newborn, systemic inflammatory diseases such as necrotizing enterocolitis, and dehydration.

Despite the handful of advances in neonatal care through ground-breaking clinical trials, the management of neonatal shock is often dependent on the bedside clinician's experience and training without the aid of high-level evidence. However, the recognition for the importance of comprehensive and serial hemodynamic assessment is growing. There is now a wealth of literature investigating the use of functional echocardiography, nearinfrared spectroscopy, and noninvasive impedance-based cardiometry to complement common bedside hemodynamic measures such as blood pressure and heart rate measurement.

In this review article, the pathophysiology of neonatal hemodynamic compromise is outlined, and concomitant best-evidence management for hemodynamic compromise in the neonate is proposed.