Topic number
1 . 2014
Neonatal infection. Respiratory therapy of neonates
Content
Editorial

Editorial

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ANNIVERSARY CONGRATULATIONS

70 лет вместе (1944–2014) (История становления и развития неонатологии в родовспомогательном учреждении)

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From medicine history

Доктор Вирджиния Апгар (1909–1974)

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News of Cochrane database

News of Cochrane database (# 1, 2014)

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Neonatology news

Neonatology news (# 1, 2014)

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International practice

Toll-like receptors in neonatal sepsis

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Toll-like receptors are vital transmembrane receptors that initiate the innate immune response to many micro-organisms. The discovery of these receptors has improved our understanding of host–pathogen interactions, and these receptors play an important role in the pathogenesis of multiple neonatal conditions such as sepsis and brain injury. Toll-like receptors, especially TLRs 2 and 4, are associated with necrotizing enterocolitis, periventricular leukomalacia and sepsis.

Conclusion: Toll-like receptor modulation may potentially be used as immunomodulators in the management of neonatal sepsis.

O’Hare F.M., Watson R.W., Molloy E.J. Toll-like receptors in Neonatal Sepsis // Acta Paediatrica. – 2013. – Vol. 102, Is. 6. – Р. 572–578.

Neonatal neutropenia: what diagnostic evaluation is needed and when is treatment recommended?

Abstract

Neutropenia is a relatively frequent finding in the neonatal intensive care unit, particularly in very low birth weight neonates during the first week of life. Healthy term and preterm neonates have blood neutrophil counts within the same basic range as adults, but their neutrophil functions, and their neutrophil kinetics during infection, differ considerably from those of adults. Neutrophil function of neonates, particularly preterm neonates, is less robust than that of adults and might also contribute to the increase in propensity to infection.

In premature infants, early-onset neutropenia is correlated with sepsis, maternal hypertension, intrauterine growth restriction, severe asphyxia, and periventricular haemorrhage, and might be associated with an increase in the incidence of early-onset sepsis, nosocomial infection, and Candida colonisation.

Some varieties of neutropenia in the NICU are very common and others are extremely rare. The most common causes of neutropenia in the NICU have an underlying cause that is often evident, and require little diagnostic evaluation. Unlike, persistent neutropenia should prompt evaluation even if it is of moderate severity. The laboratory tests to consider are those that provide a specific diagnosis. The first tests that should be ordered are a blood film, a complete blood count on the mother, and, if her blood neutrophil concentration is normal, maternal neutrophil antigen typing and an anti-neutrophil antibody screen. A bone marrow biopsy can be useful in cases with prolonged, unusual, or refractory neutropenia.

Various treatments have been proposed as means of enhancing neutrophil production and function in preterm infants. Both recombinant granulocyte stimulating factor and recombinant granulocyte macrophage-colony-stimulating factor have been tried with variable success. Intravenous immunoglobulin, corticosteroids, granulocyte transfusions, and gamma interferon did not show a clear adequate beneficial role for the therapy of neonatal neutropenia.

How can the microbiologist help in diagnosing neonatal sepsis?

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Neonatal sepsis can be classified into two subtypes depending upon whether the onset of symptoms is before 72 hours of life (early-onset neonatal sepsis– EONS) or later (late-onset neonatal sepsis–LONS). These definitions have contributed greatly to diagnosis and treatment by identifying which microorganisms are likely to be responsible for sepsis during these periods and the expected outcomes of infection. This paper focuses on the tools that microbiologist can offer to diagnose and eventually prevent neonatal sepsis. Here, we discuss the advantages and limitation of the blood culture, the actual gold standard for sepsis diagnosis. In addition, we examine the utility of molecular techniques in the diagnosis and management of neonatal sepsis.

JPGN. 2012. Vol. 54. P. 608–612.

Nosocomial colonization of premature babies with Klebsiella oxytoca: probable role of enteral feeding procedure in transmission and control of the outbreak with the use of gloves

Abstract

Objective. To investigate the persistence of colonization of premature babies by Klebsiella oxytoca, with special emphasis on the mode of transmission of the bacterium and evaluation of Standard Precautions to stop the epidemic.

Design. Retrospective analysis of cases and prospective study of systematic bacteriological samples (stools and throat) from babies, healthcare workers (HCWs), and environment, with genotyping of strains by arbitrarily primed polymerase chain reaction.

Setting. A premature baby unit (PBU) and a neonatal intensive care unit in the university hospital of Saint-Etienne, France.

Results. An outbreak of K. oxytoca was suspected in two pediatric wards after the occurrence of a fatal bacteremia in a newborn hospitalized in the PBU and the colonization of other babies 2 months later. Retrospective analysis showed that 24

babies’ digestive tract had been colonized. No environmental reservoir was recovered in the units nor in enteral feeding. No K. oxytoca was isolated from HCW samples. Genotyping confirmed the presence of epidemic strains, although independent clones were responsible for infections or colonizations in each of the two units. The chronology and the site of babies’ colonization (isolation of K. oxytoca in stools before throat) were determined during a prospective study and suggested that enteral feeding procedures could be the source of contamination. Therefore, use of gloves during this practice by HCWs was recommended and, after readjustment of Standard Precautions, stopped the outbreak.

Conclusion. To prevent cross-contamination among high-risk babies, careful attention must be paid to Standard Precautions. Bacteriological surveillance of the digestive tract of neonates could help to check compliance with these guidelines.

Infection Control and Hospital Epidemiology. – 2001. – Vol. 22, N 3. – P. 148–151.

Respiratory function parameters in ventilated newborn infants undergoing whole body

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Aim. Whole body hypothermia (WBH) exerts proven neuroprotective effects in infants with hypoxic-ischaemic encephalopathy (HIE). Our aim was to describe how WBH could impact on respiratory function in mechanically ventilated newborn infants, by recording primary and composite indices of oxygenation and ventilation before, during and after WBH.

Methods. The medical notes of 31 mechanically ventilated full-term newborn infants who underwent WBH for HIE were retrospectively reviewed. Fraction of inspired oxygen (FiO2), tidal volume (TV), mean airway Pressure (MAP), minute ventilation (MV), static compliance of the respiratory system (CstatRS), ventilation efficiency index (VEI), alveolar-arterial gradient (A-a gradient) and oxygenation index (OI) were documented before and during hypothermic treatment, as well as during and after rewarming.

Results. Fraction of inspired oxygen, MAP, OI and A-a gradient decreased during induction of hypothermia and tended to increase during rewarming. CstatRS, VEI and TV increased during induction of hypothermia and tended to decrease during rewarming. None of the changes achieved statistical significance.

Conclusion. These results suggest that WBH might affect respiratory function in mechanically ventilated infants with HIE. Oxygenation might be enhanced by hypothermia, probably as a result of decreased metabolism, while ventilation might also be facilitated as a result of the effect of hypothermia on lung mechanics.

Review

Respiratory, neurological and structure-functional sequellae of bronchopulmonary dysplasia in children and adults

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Data on respiratory, functional, structural and neurologic effects of bronchopulmonary dysplasia (BPD) in children, teenagers and young adults are presented in this review based on extensive literature and the results of our studies. Presented data argue in favor of external respiration failure persistence, including bronchial permeability failure, pulmonary diffusing capacity decreasing, hyperinflation and bronchial hyperactivity in these patients at a later age, and also remaining changes in pulmonary tissue structure. During the computer tomography of the lungs, persistent changes in the form of nonhomogenous ventilation / mosaic perfusion, raised lightness of a pulmonary tissue and emphysema in combination with local fibrous changes are defined. Designation of patients with bronchopulmonary dysplasia in anamnesis to the risk group of chronic obstructive pulmonary disease early development is proved. Bronchopulmonary dysplasia is an additional risk factor of adverse neurologic outcomes appearance, including infantile cerebral paralysis and arrested development.

Congenital deficiency of surfactant proteins

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The review prepared on the basis of current literature provides the information on the biology, physiology and metabolism of surfactant currently identified congenital defects of surfactant protein B, C, ABCA3. The characteristic of genetics, pathophysiology, clinical manifestations and treatment of congenital deficiency of surfactant is presented. Morphological and image-diagnostic and outcomes of these diseases are described.

Role of simulation and training technologies in the training of health-care personnel for perinatal centers

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In this article main problems of modern medicine in the field of continuous medical education are described. Relevance of carrying out such events as: implemented of modern perinatal technologies into healthcare practices, retrofits and conversions of maternity homes and children's hospitals with modern medical equipment is reflected. It is necessary to create new large perinatal centers, organization of perinatal help three-tier system, urgent medical professional retraining for physicians and middle-level medical personnel is necessary. Besides problems of acute physician and middle-level medical personnel shortage are described. Necessity for educational centers for medical simulation in modern perinatal technologies and reorganization of the medical professional training and retraining system is proved.

SHARING EXPERIENCES

The procedure for examination of newborns suspected of infectious pathology and rules of antibacterial therapy, adopted at Department of resuscitation and intensive therapy of newborn at Kulakov Research Center for Obstetrics, Gynecology and Perinatology

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Aim. Creation of guidelines for screening of newborns with suspicious infections and for antibacterial therapy in neonatal intensive care unit of Research Center for Obstetrics, Gynecology and Perinatology.

Material and methods. Newborns admitted for examination and treatment intensive care unit of Research Center for Obstetrics, Gynecology and Perinatology were included.

Results. We developed the unified guidelines for newborns screening and antibacterial therapy principles in neonatal intensive care unit. This protocol is based on analysis of literary data.

Conclusion. New clinical protocol can be recommended for use in neonatal intensive care units for screening of newborns with suspicious infections and for optimizing approaches for antibacterial therapy carrying out.

Annexes to the Protocol of the survey and the order of carrying out of antibacterial therapy in children in the intensive care unit and neonatal intensive care of Federal State Budget Institution "Research Center for Obstetrics, Gynecology and Perinatology" Ministry of Healthcare of the Russian Federation

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Red blood cell distribution width in newborns: preliminary report

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Background. Red Blood Cell Distribution Width (RDW) – represents the heterogeneity of red blood cell volume, and, being essentially as integral index, is a quantitative assessment of anisocytosis. Many diseases are accompanied by significant changes in the size and volume of red blood cells, thus, now in the medical literature RDW regarded as a universal marker and a harbinger of numerous pathological processes. RDW is considered not only as an indicator used in the laboratory assessment of anemia, but also as a marker of inflammation, cancer pathology, diseases of the gastrointestinal tract and the cardiovascular system. However, the number of studies in infants focused on estimating of diagnostic and prognostic significance of RDW is extremely limited.

Purpose: to determine normative ranges of RDW in fullterm newborn infants in the early neonatal period and evaluate its diagnostic value.

Materials and methods. A retrospective study. Total analyzed the medical records of 75 full-term newborns. The children were divided into 2 groups. The first group included healthy neonates – 52 children, the second – infants who were met laboratory criteria of infection from the first days of life – 23 children. Sampling of peripheral blood for clinical laboratory testing was performed at the age of 1–2 days of life.

Results. Average value of RDW in healthy full-term newborns in our study corresponded to 13,92%. In infants with laboratory criteria that confirm presence of an infectious process, RDW was significantly higher than in healthy children, and averaged 16,35% (p<0,001). There were no statistically significant differences between the groups for the average values of main indices of red blood cells, and there was no statistically significant correlation between RDW and levels of erythrocytes and hematocrit.

Conclusions. RDW may be used in newborns as a marker of infection. However, the clinical significance of this criterion in newborns should be the subject of further research, particularly in infectious pathology.

Clinical practice guidelines

The commentary on the draft clinical protocol "newborns parenteral nutrition", published in the journal "Neonatology. News. Opinion. Training" № 2, 2013

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Diagnosis and treatment of neonatal hypoglycemia

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Keeping newborns with respiratory distress syndrome. Methodical recommendations under the editorship of academician RAMS N. N. Volodina

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The draft clinical protocol on diagnosis and treatment of persistent pulmonary hypertension in newborns

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Проект протокола по диагностике, профилактике и лечению бронхолегочной дисплазии

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Management of the umbilical cord, prevention and treatment of omphalitis

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Lawyer column

Fringe benefit: needle's eye of neonatologist

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Announcements

Announcements (# 1, 2014)

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All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)

CHIEF EDITOR
CHIEF EDITOR
Degtyarev Dmitriy Nikolaevich
Doctor of Medical Sciences, Professor, Deputy Director for Scientific Research of the V.I. Kulakov Obstetrics, Gynecology and Perinatology National Medical Research Center of Ministry of Healthсаre of the Russian Federation, Head of the Chair of Neonatology at the Clinical Institute of Children's Health named after N.F. Filatov, I.M. Sechenov First Moscow State Medical University, Chairman of the Ethics Committee of the Russian Society of Neonatologists, Moscow, Russian Federation

ORCID iD 0000-0001-8975-2425

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