Premature infants at the limits of viability raise difficult ethical, legal, social and economic questions. Neonatologists attending an international Collegium were surveyed about delivery room behaviour, and the approach taken by selected countries practicing «modern » medicine was explored.

Conclusion. There were strong preferences for comfort care at 22 weeks and full resuscitation at 24 weeks. Resuscitation was a grey area at 23 weeks. Cultural, social and legal factors also had a considerable impact on decision-making.

Aim: to validate and evaluate the psychometric properties of the ALPS-Neo, a new pain assessment scale created for the continuous evaluation of pain and stress in preterm and sick term infants.

Methods. A unidimensional scale for continuous pain, Astrid Lindgren Children’s Hospital Pain Scale (ALPS 1), was developed further to assess continuous pain and stress in infants treated in the neonatal intensive care unit (NICU). The pain scale includes observations of five behaviours. A manual was created, clarifying the scoring criteria. An internal and an external panel assessed face validity. Psychometric properties were evaluated in three different steps.

Inter-rater reliability was estimated from video-based assessments (n=625) using weighted kappa statistics (test I). Inter-rater reliability was further evaluated in test II (n=125) and test III (n=96) by real-time assessments using the intraclass correlation coefficient (ICC) and Cronbach’s alpha.

Results. The final inter-rater reliability (test III) was assessed as good with ICC 0,91 for the total score and 0,62–0,81 for the five items. Cronbach’s alpha showed 0.95 for the total score.

Conclusion. ALPS-Neo is a new assessment tool for optimising the management of pain and stress in newborn infants in the NICU. It has proved easy to implement and userfriendly, permitting fast, reliable observations with high inter-rater reliability.

Aim. To determine the aetiological associations, neurological sequelae and role of magnetic resonance imaging (MRI) in term newborn infants with seizures.

Methods. Cohort study of infants ≥37 weeks’ gestation delivered in a tertiary level centre, prospectively identified and followed longitudinally for 18–24 months.

Results. An underlying aetiology was found in 95 % of the 77 infants identified with seizures (3,0/1000 live births).

The most common diagnosis was hypoxic – ischaemic encephalopathy (HIE) (65 %), followed by neonatal stroke (12 %). 9 infants died, 28 of the 68 survivors developed neurodevelopmental impairment (NDI), and 15 had recurrent seizures in the first 2 years, with both outcomes more likely in those with a diagnosis other than HIE. Abnormal MRI findings were found in 45 of the 70 infants imaged. The absence of major cerebral lesions was highly predictive of a normal neurological outcome.

Conclusion. We report the first cohort of term infants with seizures fully investigated by MRI. The universal use of MRI enabled a cause to be identified in 95 % of cases.

The probability of having NDI or recurrence of seizures was extremely low with absence of major cerebral lesions on MRI.

This study demonstrates the added value of MRI for diagnosis of aetiology and the prediction of neurological outcome.

Considering the frequent development of the combined bronchopulmonary and gastrointestinal pathology caused by a community of an embryological origin expedient studying of nature of influence of dysfunctions of a gastrointestinal tract on bronchopulmonary system is. In article the detailed characteristic of anatomicofunctional features of a gastrointestinal tract of newborn children is given, and also the most significant pathological factors promoting development of functional pathology of gastrointestinal system in the neonatal period are allocated. Pathogenetic mechanisms of development of microaspiration of gastric contents, and also morphological and histochemical changes in bronchopulmonary system under the influence of acid and peptic components in tracheobronchial aspirate are described.

This article presents issues of early enteral (trophic) nutrition for preterm infants. Gathered scientific data testify that human breast milk, especially mother’s milk cannot improve the growth and development of premature infants, so breast-milk substitutes and human milk fortifiers were recently introduced in the clinical practice. The consequences and complications of low weight gain due to low protein intake (or high protein intake) in early life are presented. The problems of breast feeding for preterm infants with a review of human breast milk all the important components, as well as the detailed analysis of breast-milk substitutes and human milk fortifiers composition and their pros and cons are discussed.

Persistent pulmonary hypertension of the newborn remains unfavorable for disease course and outcome of the disease in the newborn. All selective vasodilators for neonates have the off-label status in our country, the article analyzed the studies of nitric oxide therapy in persistent pulmonary hypertension of the newborn and premature babies, as well as examine the technical and organizational aspects of this technology аt newborn.

The respiratory distress syndrome of newborns is one of the most common critical states in neonatal period. It is associated with progressing hypoxemia and requires high-invasive methods of respiratory support. Along with surfactant replacement therapy alveolar recruitment maneuver is the most promising and pathogenetically reasonable strategy of respiratory stabilization in premature infants. This technique of respiratory therapy is widely used in adults now, while safety and clinical efficiency of recruitment maneuver for neonatal resuscitation still needs to be proved.

Aim of the work was to study the efficacy of recruitment maneuver in premature infants with respiratory distress syndrome by analyzing the clinical and laboratory patient statuses and the disease outcomes in early and long-term periods and also to define the optimal time for the maneuver application.

Material and methods: our study enrolled 51 premature infants with clinical manifestations of respiratory distress syndrome. The average birth weight was 1343 (±125) grams. In 24 newborns (group 1) the respiratory distress was accompanied by expressed hypoxemia which was the indication to perform the recruitment maneuver (alveoli opening). In order to evaluate the recruitment maneuvers efficacy in long-term outcome 27 newborns with similar clinical presentation and provided therapy, but without the recruitment maneuver, were also included in our research.

Results. It is found that the recruitment maneuver provided to premature infants with respiratory distress syndrome significantly improves blood oxygenation and mechanical characteristics of lungs. It is shown that the optimal time to perform the recruitment maneuver is the second or third day of life.

Conclusion. Alveolar recruitment maneuver has high clinical efficacy in premature infants with RDSN. It promotes fast and significant decrease in lungs ventilation parameters and reduction of numerous complications of the main disease.

Аim of this study was to determine the significance of procalcitonin in the diagnosis of infectious and inflammatory diseases in newborns.

Material and methods. The work included data from 160 infants with very low and extremely low birth weight received for examination and treatment in resuscitation and intensive care unit of V.I. Kulakov Obstetrics, Gynecology and Perinatology Research Center of Ministry of Healthcаre of the Russian Federation, Moscow from January 2012 to April 2014.

Results. On the basis of own experience and literature data the significance of procalcitonin in the diagnosis of infectious and inflammatory diseases in newborns was estimated. The clinical guidelines that define the extent of examination of newborns who are at high risk of acquiring an infection, and principles of antibiotic therapy administration are developed.

Conclusion. The developed clinical recommendations can be proposed for use in resuscitation and intensive care units as a tool to select a group of newborns who are at high risk of acquiring an infection, which determines the order of this newborns examination and approaches to antibiotic therapy administration.