Clinical and laboratory indicators of lethal outcome in premature newborns with body weight less than 1500 grams
Background. The problem of predicting an unfavorable outcome is still relevant, especially in premature infants, since they constitute a high-risk group on the basis of mortality, morbidity and disability.
Objective. To analyze individual clinical and laboratory parameters of the mother before delivery and of the premature newborn at the age of the first 72 h of life in order to find out the mortality indicators in the neonatal period.
Material and methods. The study is cohort, retrospective, comparative, conducted in the Donetsk Clinical Territorial Medical Association (Donetsk) in the period from 2014 to 2019. A total of 166 preterm infants with the birth weight less than 1500 grams were examined. Patients with congenital malformations, chromosomal and genetic abnormalities were excluded. 2 groups: group 1 (48 children) - lethal outcome: group 2 (118 children) -survived and discharged to home.
Results. In group 1, infants were born earlier (26.5 vs 29.0 weeks; p<0.001), with less body weight (710.0 vs 1190.0 grams; p<0.001), smaller height (32.0 vs 37.0 cm; p<0.001), as well as lower Apgar scores (2/4 points versus 5/6 points at the 1st and 5th minutes of life; p<0.001). The median probability of survival (95% confidence interval) was the highest for singleton pregnancies - 0.87 (0.8-0.91), less for twin pregnancies - 0.75 (0.53-0.88), the lowest in the case of triplets - 0.5 (0.11-0.8). The mothers in the group of the deceased patients had a statistically significant lower hemoglobin level [106.0 g/L [97.0; 117.0] vs 112.5 g/L [104.0; 127.0]; p=0.009], a higher platelets level [2 60.0x109/L [198.5; 297.0] vs 2 28.5x109/L [190.75; 263.5]; p=0.026], and a lower urea level in blood biochemistry test [3.0 mmol/L [2.6; 4.0] vs 4.0 mmol/L [3.12; 5.0]; p<0.001]. In deceased infants, the absolute number of neutrophils in the blood on the 1st day of life was statistically significantly lower in comparison to the surviving infants: 3080.0x109/L [1449.0; 6837.5] vs 5 2 20.0x109/L [2471.25; 8846.5]; p=0.029.
Conclusion. Multiple pregnancies, the levels of hemoglobin, platelets, eosinophils and urea in the mother's blood before childbirth and the absolute number of neutrophils on the 1st day of life and the relative number of monocytes on the 2nd day of life in premature infants weighing less than 1500 grams at birth can be used as additional predictors of mortality.
Choice of tactics for feeding premature babies with functional immaturity of movements of the articulatory apparatus (part 1)
Impaired sucking and swallowing function is characteristic of premature babies with various perinatal pathologies. Successful feeding depends on the child's ability to coordinate muscles of the oral cavity, upper half of the trunk and respiratory system. Therefore, the study of the state of articulation motility and the search for ways to stimulate the sucent reflex and the coordinated functioning of the muscles of the face, tongue and soft palate is especially relevant in such patients. A speech examination showed the dependence of the nature of feeding on the state of tone of the muscles of the articulation organs. Increased muscle tone causes impulsive sucking, rapidly depleting sucking movements; reduced muscle tone - immature, sluggish sucking, draining movements with tongue and lips; mixed tone - non-rhythmic sucking, coordinated movements of the tongue and lips. Thus, the state of tone of facial muscles determines the tactics of speech treatment for the development of articulatory capabilities in preterm infants when sucking and swallowing processes are disturbed. Thus, the state of the tone of the facial muscles determines the tactics of feeding. It is also an indication for the beginning of speech therapy influence on the development of articulatory capabilities in premature babies in violation of the processes of sucking and swallowing. The methods and volume of speech therapy assistance in the comprehensive rehabilitation program are selected according to the results of the child's speech therapy examination in order to normalize the tone of the muscles of the facial muscles and ensure the possibility of self-sucking.
Association of the PPARA gene polymorphism with gestational age in low birth weight infants born to mothers with diabetes mellitus
Currently, perinatal programming is being discussed in the context of the adverse effects of hyperglycemia in gestational diabetes mellitus (GDM) on fetal growth, fetal macrosomia is the most common complication of this disease. The polymorphism of genes associated with diabetes mellitus has been described, including during pregnancy, but there are practically no data on the effect of these genetic factors on the fetus. The role of polymorphism of genes, involved in lipid and carbohydrate metabolism, and affecting fetal formation is relevant, since it can explain the relationship between birth weight, maternal diabetes mellitus and the later obesity in a child. The study group consisted of 90 pregnant women with diabetes mellitus and their newborn babies, 71 babies were born corresponding to the gestational age, 4 large babies, 15 babies were born underweight by the gestational age. Diagnosis and treatment of women with diabetes was carried out in strict accordance with the Russian national consensus on the management of patients with GDM (2012). It was found that the genotypic frequency of the C allele of the rs4253778 polymorphic locus of the PPARA gene was significantly higher in the group of children born with normal body weight and large-weight by the gestational age, and amounted to 20.7%, compared with the group of low birth-weight children by the gestational age - 3.3% (p=0.023). The data obtained indicate the important role of the fetal genotype in the formation of the mass-growth parameters of the child with diabetes mellitus in the mother. The mother's genotype did not have such a significant effect on the birth of a small baby. In the observed group, the frequency of birth of large-weight children was significantly less than that of low-birth-weight, which, apparently, reflects the effectiveness of pregnancy management tactics. At the same time, taking into account the association of alley C with obesity, and its protective role in the development of microsomia, it is necessary to pay attention to infants born to mothers with diabetes mellitus, even if their birth weight appropriate for gestation age.
Possibilities to improve the effectiveness of audiological screening in neonatal practice
The article is devoted to the possibilities of improving the quality and efficiency of hearing screening in newborns. The data on modern screening methods are presented, the features of hearing diagnostics in premature babies are noted. The emphasis is made on the prospects for improving the audiological screening system.
Early anemia of preterm infants (guideline)
The article presents the guideline of management of the newborns with early anemia of preterm infants: definition, etiology, diagnostics and treatment of this disease with evidence based practice, algorithm of management and health care quality criteria.
Difficulty in diagnosing congenital tuberculosis with unknown history
The article describes a clinical case devoted to the problem of diagnosing congenital tuberculosis, which is related to casuistic cases in the modern world. The development of clinical, laboratory and instrumental signs of the disease is analyzed from the appearance of the first symptoms of congenital tuberculosis to the generalization of the process and multiple organ failure with subsequent fatal outcome. The article emphasizes the need for a detailed collection of an antenatal anamnesis and the formation of a doctor's communicative competence to ensure compliance with the purpose of timely diagnosis and treatment of diseases.
Pathoanatomic autopsies: new technologies and unsolved problems
The article discusses the general procedure for conducting pathoanatomic autopsies in accordance with the current Legislation of the Russian Federation, the problems that arise during pathoanatomic autopsies and the delivery of bodies to relatives, as well as the prospects for the development of non-invasive autopsy techniques in our country.
Effect of therapeutic hypothermia on renal and myocardial function in asphyxiated (near) term neonates: a systematic review and meta-analysis
Therapeutic hypothermia (TH) is a well-established neuroprotective therapy applied in (near) term asphyxiated infants. However, little is known regarding the effects of TH on renal and/or myocardial function.
Objectives. To describe the short- and long-term effects of TH on renal and myocardial function in asphyxiated (near) term neonates.
Methods. An electronic search strategy incorporating MeSH terms and keywords was performed in October 2019 and updated in June 2020 using PubMed and Cochrane databases. Inclusion criteria consisted of a RCT or observational cohort design, intervention with TH in a setting of perinatal asphyxia and available long-term results on renal and myocardial function. We performed a meta-analysis and heterogeneity and sensitivity analyses using a random effects model. Subgroup analysis was performed on the method of cooling.
Results. Of the 107 studies identified on renal function, 9 were included. None of the studies investigated the effects of TH on long-term renal function after perinatal asphyxia. The 9 included studies described the effect of TH on the incidence of acute kidney injury (AKI) after perinatal asphyxia. Meta-analysis showed a significant difference between the incidence of AKI in neonates treated with TH compared to the control group (RR=0.81; 95% CI 0.67-0.98; p=0.03). No studies were found investigating the long-term effects of TH on myocardial function after neonatal asphyxia. Possible short-term beneficial effects were presented in 4 out of 5 identified studies, as observed by significant reductions in cardiac biomarkers and less findings of myocardial dysfunction on ECG and cardiac ultrasound.
Conclusions. TH in asphyxiated neonates reduces the incidence of AKI, an important risk factor for chronic kidney damage, and thus is potentially renoprotective. No studies were found on the long-term effects of TH on myocardial function. Short-term outcome studies suggest a cardioprotective effect.