Early identification of neonates with a high probability of necrotizing enterocolitis (NEC) before the first clinical signs is crucial for developing “warning” NEC algorithms and targeted treatment strategies. Recent studies demonstrate that IL‑8 is a promising predictor of surgical NEC. However, there is insufficient evidence to determine whether these findings are influenced by gestational age (GA) or early-onset neonatal sepsis (EONS).

Aim: to evaluate the predictive value of plasma cytokines in NEC for the cohort of preterm neonates.

Material and methods. The prospective cohort study included 78 inborn neonates (GA <33 weeks and/or birth weight ≤1500 g) admitted to the level III NICU during the first hour of life from September 2021 till December 2022. All neonates underwent blood sampling for 17 cytokines measurement (Bio-Rad, USA) on the day of life (DOL) 3 and 7. At the end of the follow-up period, all neonates were divided into 2 main groups: group 1 (patients with NEС, n=13) and group 2 (without NEC, n=64). The stratified analysis was performed to exclude possible confounding by GA and EONS.

Results. The subgroups by GA were comparable in GA, birth weight, and EONS incidence. NEC was diagnosed in 13/78 neonates (16.6%): in 9 out of 17 in the subgroup GA <29 w (53%) and in 4/61 (6.6%) – among those with GA ≥29 w. NEC stage ≥2b was observed in 29% (5/17) in subgroup GA <29 w and in 1.6% (1/61) in subgroup GA ≥29 w. Compared to those without NEC, neonates with NEC had elevated levels of cytokines: IL‑8 and IL‑10 on DOL 3 and IL‑8, MIP‑1β – on DOL 7. However, only the increase of IL‑8 was statistically significant regardless of GA and EONS. ROC analysis showed a high predictive value of IL‑8 on DOL 3 and 7 (in subgroup GA <29 w on DOL 3 AUC =0.86, cut-off value =36.36 pg/ml, p<0.001; on DOL 7 AUC =0.96, cut-off value=17.7 pg/ml, p<0.001).

Conclusion. Our data suggest that the elevation of the IL‑8 plasma level can be considered an early biomarker of NEC, which is informative starting from DOL3 in preterm neonates of different GA with or without EONS. Il‑8 becomes informative several days before NEC onset. Further research is needed to determine accurate cut-off values that factor in gestational age and the presence of EONS.

The significance of the neonatal thrombosis is underestimated. This rare (0.7–0.14 in 10 thousands) disease can occur pre- or postnataly and leads to unwilling outcomes. The problem of neonatal thrombosis requires effective early methods of prognosis.

The aim of this work was to study the prognostic significance of the thrombodynamics test in newborns at high risk for the development of thrombosis.

Material and methods. The study included 105 newborns. 81 infant have severe neonatal infections, 48 (59%) out of 81 infant developed thrombosis. 24 infant without signs of severe neonatal infections and thrombosis were taken as a comparison group. The presence of blood clots was detected by clinical signs and ultrasound data with Doppler effect. Along with standard clinical examination and lab tests the coagulation hemostasis was studied by standard parameters in parallel with the integral test of hemostasis such as thrombodynamics. Test were taken in two control points: the first time at the beginning of infection (at the same age at comparison group), the second time after 3 days.

Results. In the group of children with perinatal infection, the indicators of the standard coagulation tests did not significantly differ from the comparison group, where as according to thrombodynamic, the indicators indicating a greater tendency to thrombosis (the increases rate of clot formation, the growth of spontaneous clots) were significantly higher. The abnormally quick rate of clot formation leads to 3.2 (95% CI 1.3–8.2) significantly higher risk of thrombosis in children with perinatal infections. The indicators of both methods used in subgroups of children with perinatal infection with and without thrombosis did not differ.

Conclusion. Thrombodynamic test unlike standard coagulation tests can demonstrate the tendency to hypercoagulation in infant with severe neonatal infections. Abnormally quick rate of clot formation leads to 3.2 significantly higher risk of thrombosis in children with perinatal infections.

Iron deficiency (ID) in premature infants is known to be associated with a delay in neurodevelopmental outcomes. Therefore, timely diagnosis of this condition is extremely important. Hepcidin (Hep) is a hormone regulates iron metabolism and can be used as an additional marker for the diagnosis of ID.

The objective of the study was to evaluate the correlation of serum Hep concentration with erythrocyte’s indexes (MCV, MCH, MCHC, RET-He) and iron metabolism indicators (serum ferritin, iron, transferrin), and to determine the diagnostic significance of Hep for the diagnosis of ID in premature infants weighing less than 1000 g at birth in the late neonatal period.

Material and methods. The prospective cohort study included 106 infants weighing less than 1000 g at birth. Infants at the age of 14 to 21 days of life were laboratory examined including determination of MCV, MCH, MCHC, RET-He, serum Hep, serum ferritin, serum transferrin and serum iron. Depending on the presence of ID, infants were divided into 2 groups: group 1 – infants with ID (n=55); group 2 – infants without ID (n=51).

Results. The significant correlations of serum Hep with such indicators as serum ferritin (r=0.97, p=0.012), MCV (r=0.71, p=0.020), MCH (r=0.62, p=0.035), MCHC (r=0.61, p=0.035), RET-He (r=0.77, p=0.023) were determined. Serum Hep was significantly lower in infants with ID. The threshold value of Hep (≤6.4 ng/ml) was determined, associated with a high probability of ID (Se=86.7% and Sp=76.4%). A low serum Hep indicates a lack of total iron storage in premature infants, reflecting an increased need for iron in this category of infants. The difference between serum iron and transferrin concentrations was not statistically significant among the groups.

Conclusion. The correlations between serum Hep, ferritin, MCV, MCH, MCHC, RET-He were found in premature infants weighing less than 1000 g at birth in the late neonatal period. The diagnostic value of determining the concentration of serum Hep in the presence of ID has been demonstrated.

The prevalence of transient isolated hyperthyroidism (TIH) in premature infants has not been fully studied. It has known that premature birth is a risk factor for the development of this phenomenon. Studies on hormonal dysfunction in premature infants are of the great interest.

The aim of the study was to determine the prevalence of TIH in premature infants and identify possible links between thyroid stimulating hormone (TSH) levels, and early neonatal characteristics. The study analyzed the possibility of predicting various complications of the postnatal period based on TSH levels during primary screening.

Material and methods. The study was conducted at the Medical Genetic Center of the Republic of Bashkortostan. A retrospective analysis of screening data for congenital hypothyroidism for 2021–2023 was conducted. The study included premature infants with a gestation period of 22–36 weeks, with an increase in TSH during the initial testing of no more than 20 mIU/L. The exclusion criteria were premature infants with severe multiple malformations, confirmed by the diagnosis of congenital and transient hypothyroidism. Statistical analysis of the obtained results was performed using the StatTech v. 4.1.4 program (developer – StatTech LLC, Russia). Comparison of two groups by a quantitative indicator, the distribution of which differed from the normal one, was performed using the Mann-Whitney U-test. To assess the diagnostic significance of the TSH level during the initial testing in order to predict the outcome of the postnatal period of premature infants, the receiver operating characteristic (ROC) curve analysis method was used.

Results. The proportion of children with hyperthyroidism in the population of premature newborns was 72 cases, which corresponds to 1% during the analyzed period from 2021 to 2023 in the Republic of Bashkortostan. It was found that in the group of premature babies with elevated TSH levels: 4.1% diagnosed congenital hypothyroidism; 5.5% diagnosed transient hypothyroidism, and 22.2% transient isolated hyperthyroidism. In the study group with isolated hyperthyroidism, the TSH level was in the range of 5–20 mU/l. Levels of free tetraiodothyronine (T₄) were 84.94±29.6 nmol/l and triiodothyronine (T₃) 1.1±0.43 nmol/l. Statistically significant correlations were found between the TSH level and the presence of RDS syndrome, asphyxia during childbirth, and CHD in the newborn. The prognostic model showed an inverse relationship with RDS and asphyxia during childbirth. In the prediction of these conditions, the TSH level will be below the cut-off point of 17.70 and 20.21 mU/L, respectively. In the presence of CHD, the cut-off point was a TSH value of 15.99 mU/L.

Conclusion. TSH in premature infants is a significant risk factor for the development of various complications. The TSH level can serve as a prognostic marker for identifying children with a high risk of developing RDS, asphyxia and congenital heart defects. The obtained results are needful for further research. The field of medicine can develop more effective strategies for managing premature infants with elevated TSH levels.

Newborns in the Russian Federation have been examined for 31 congenital hereditary diseases (neonatal screening (RNS)) since 1st of January till 31st of December 2023. 10 competence centers 3A and a reference 3B center were organized to implement this program. One of the level 3A competence centers was opened in Irkutsk to examine newborns in three regions: the Irkutsk’s region, the Republic of Buryatia and the Trans-Baikal territory.

The aim of the study was to assess the frequency and a structure of pathology detected in newborns (RNS) in the three regions by the end of 2023.

Material and methods. The research material was sampled by dry bloodstains. Biomaterial sampling was carried out in medical institutions for obstetric care. The studies were conducted using two methods: tandem mass spectrometry was used to screen for 29 hereditary metabolic diseases (HBO S), polymerase chain reaction screening for primary immunodeficiency (PID) and spinal muscular atrophy (SMA).

Results. 43 151 newborns from the Baikal region were screened at the 3A Competence Center, including 22 920 (53.12%) from Irkutsk’s region, 10 291 (23.85%), the Republic of Buryatia, 9940 (23.03%), the Trans-Baikal Territory from 1st of January to 31st of December 2023.

408 newborns were classified as high-risk for congenital hereditary diseases, including 239 newborns with suspected HBOS (1:180.5), 164 for PID (1:263.1), 5 for SMA (1:8630.2).

The diagnosis was confirmed by 20 newborns, including 13 with HBOS (phenylketonuria 1:4794; methylmalonic aciduria 1:21575; propionic aciduria 1:43151; tyrosinemia 1:43151 live births who underwent RNS), 4 – PID (1:10 788 live births who underwent RNS), in 3 – SMA (1:14384 live births who underwent RNS) in the 3B competence center.

Conclusion. The frequency of the detected pathology in Irkutsk’s region, the Republic of Buryatia and the Trans-Baikal territory according to the results of the first year of the RNS is comparable with global data and data obtained in other regions of the Russian Federation.

Vitamin D deficiency is a global public health problem. One of the generally accepted risk factors for the development of vitamin D deficiency is overweight in a pregnant woman.

Objective: to determine the level of vitamin D provision for newborns in the group of overweight pregnant women living in the Khabarovsk territory.

Material and methods. 35 mother–child couples were included in the study by random samplings. Full term newborns (n=35), diagnosed at birth with Z38.0 according to ICD‑10, and their mothers (n=35) with a body mass index (BMI) at the time of delivery ≥30 kg/m². The average index in the mother’s group was 32.48±0.38 kg/m². The control group of the mother–child pair: healthy full-term newborns (n=54), with a conclusion at birth of Z38.0 according to ICD‑10, and the mothers of the children with a normal BMI (n=54). Quantification of the level of 25-hydroxyvitamin D (25(OH)D) in the serum of umbilical cord (children) or venous (mother) blood by enzyme immunoassay was performed.

Results. It was found that the average calcidiol value in the study group of newborns is more than 2 times lower than in newborns in the control group (21.9 and 49.8 ng/ml, respectively, p=0.000). Also, 11.4±5.4% of children in the study group showed a decrease in the level of phosphorus ions. The correlation analysis revealed a positive statistically significant relationship between the levels of calcidiol and inorganic phosphorus in the blood serum of newborns (r=0.337; p=0.047).

Conclusion. It was found that vitamin D level in children born from mothers with a BMI >30 kg/m² were lower than in children during the physiological course of pregnancy. This fact demonstrates the necessity of adequate control of vitamin D provision for women to reduce the risk of pregnancy complications and the negative effect on the intrauterine child development.

Over the past decade, enteral and parenteral nutrition practices for premature infants have undergone significant changes. Currently, for this category of neonates, experts from the European Society of Paediatric Gastroenterology, Hepatology and Dietetics (ESPGHAN) have proposed a nutritional strategy based on different enteral protein supplements depending on the postnatal growth trajectory, rather than on actual body weight indicators, as was previously the case. The goal of this strategy should be to achieve a rate of weight and length gain in a premature infant in a hospital setting that will be similar to its determined intrauterine growth rate, and also correlate with favorable somatic outcomes. The expected result will determine the strategy as justified and a priority for feeding premature infants from birth until discharge from a hospital, and will also facilitate wider implementation in neonatal practice.

Objective. To evaluate the effectiveness of enteral feeding method in premature infants of different gestational ages in a hospital based on the dynamic assessment of anthropometric and vital signs.

Material and methods. The observational prospective single-center study included 40 premature infants: in 1st group included 20 infants with birth weight <1800 g (gestational age 32.1±1.1 weeks, birth weight 1519.1±213.9 g), group 2 consisted of 20 infants with birth weight ≥1800 g (gestational age 34.4±1.4 weeks, birth weight 2259.4±281.0 g). In our study, the criterion of growth failure was the difference between the birth weight and the examination weight by more than -1SD, which determined the correction of enteral nutrition with an increase in the daily protein supplementation for children in group 1 to 4.1–4.5 g/kg and for group 2 to 3.6–4.0 g/kg per day. In the absence of growth failure, the daily enteral protein supplementation for children in group 1 was 3.5–4.0 g/kg and for group 2 3.0–3.5 g/kg. Breast milk content in the groups was less than 50% of the daily enteral volume. Breast milk administration in full volume was impossible due to severe somatic pathology of mothers, complicated course of their pregnancy and postpartum period Special cow’s milk formula for premature babies, such as Nutrilon Pre 0 and Nutrilon Pre 1 with the lipid complex Pro Lipids, were used as the main enteral product. Anthropometric parameters were assessed at birth and every decade until the 30th day of life or until discharge, if it occurred earlier.

Results. In group 1, no cases of postnatal growth failure were registered on the 20th day of life. Therefore, enteral nutrition was corrected by reducing the protein supplementation from 4.1–4.5 to 3.5–4.0 g/kg per day. On the 30th day of life, no patient demonstrated a deviation of the postnatal growth trajectory by more than -1SD from the initial indicators at birth, there was no need to increase the enteral protein supplementation. At the time of enteral nutrition correction, the body weight in group 1 was 1702.8±46.4 g, in contrast to the standard nutritional approach, where the criterion for transferring to a formula with a lower protein content is a body weight of 1800 g without interpretation of anthropometric indicators. In group 1, the postnatal rate of weight gain after the initial weight loss was 15.74±2.22 g/kg per day, which corresponds to the intrauterine growth rate of the third trimester.

Throughout the study period, no cases of postnatal growth failure were detected in group 2, which allowed us to continue the previously initiated starting protein supplementation of 3.0–3.5 g/kg per day without the need to increase it and change the enteral substrate to a formula with a higher protein content. Postnatal weight gain in group 2 after the initial weight loss was 12.98±2.74 g/kg per day, which corresponds to the intrauterine growth rate of the last weeks of the third trimester.

Conclusion. The method of enteral feeding in premature infants of different gestational ages in a hospital using Nutrilon Pre 0 and Nutrilon Pre 1 formulas with the lipid complex Pro Lipids as the main nutrition and supplementary feeding, based on a dynamic assessment of the anthropometric and somatic status, determines the similarity of the postnatal growth rate in the study groups with the genetically determined intrauterine growth rate, which determines the effectiveness and safety of the proposed nutritional strategy in the neonatal period.

Lung ultrasound (LUS) in neonates is being used more frequently to diagnose pulmonary pathology due to its advantages, such as accuracy, quickness and ease of performance. In addition, this method is devoid of radiation exposure to the growing organism of children. Neonatal respiratory distress syndrome (RDS) remains the most frequent cause of hospitalization for premature infants in intensive care units, and its early diagnosis and timely treatment are crucial for a successful outcome. LUS can provide a differential diagnosis of RDS and also help to determine the indications for initiating surfactant therapy. Review highlights the methodology of LUS in neonates, with a detailed description of possible ultrasound profiles and principles of evaluation of the results obtained. The objective of the review is to present current data on the use of LUS for the diagnosis of pulmonary pathology in newborns, as well as the possibility of using this method to determine the treatment of RDS.

Methylmalonic (MMA) and propionic (PA) acidemia are lethal, severe heterogeneous disorders with early onset manifestation. Since January 2023, methylmalonic and propionic acidemia included in the newborn screening program in the Russian Federation. Our aim was to describe the clinical and molecular genetic features of methylmalonic and propionic acidemia in the Irkutsk region.

Material and methods. MMA and PA patients were evaluated for their phenotype, biochemical abnormalities, genotype, and outcomes.

Results. 6 patients were identified with MMA and PA. The patients represented belong to 3 ethnic groups. In 3 children, the disease was diagnosed after manifestation, in 3 during newborn screening. Patients identified during screening have a more favorable clinical course.

Conclusion. This study cohort had MMUT subtype as the most common type of MMA. Outcomes in MMA are influenced by the type of molecular defect, the age of manifestation and the time of initiation of treatment. Patients identified during newborn screening have better results.

The new section of the journal “Neonatology: News, Opinions, Training” is devoted to bioethics, a scientific discipline, one of the tasks of which is to find morally justified and socially acceptable solutions, which arise in the process of developing and applying new medical technologies. The appearance of this section is connected with the need for a comprehensive consideration of the moral and ethical dilemmas caused by the introduction of the latest biotechnologies into perinatal medicine.

The article investigates the main stages of the formation of bioethics, as well as its place in the structure of modern scientific knowledge.

The aim of the work was to analyze the features of the development of bioethics from its origins to its transformation into an independent scientific discipline.

Material and methods. the methodological basis of the research is a comparative analysis of academic literature in the field of bioethics and related sciences (history and philosophy) and systematization of its content.

The article analyzes the current state of the problem of conducting pathoanatomic autopsies in the Russian Federation and in the world, identifies gaps in legislation (including the conceptual apparatus), analyzes the prospects for the regulatory consolidation of advanced technologies of pathoanatomic autopsies (non-invasive and minimally invasive) in our country.

The article describes some acute stress reactions of parents whose children are in the neonatal intensive care unit, as well as methods of emergency psychological support.

On October 1, 2024, in Moscow, within the framework of the XXV All-Russian Scientific and Educational Forum «Mother and Child», an open expert council on clinical and organizational issues of using glutamine in newborns was held.