Perinatal and neonatal outcomes with coronavirus disease 2019 (COVID-19) in the Khabarovsk territory
The COVID-19 pandemic has led to significant changes in the provision of medical care, clinical management of pregnant women and newborns. Starting from the first, general “temporary” methodological recommendations, followed by specialized ones for pregnant women and newborns and children older than a month, interpreted the clinic, diagnostics, tactics due to the knowledge that was at the moment, but the availability of medical resources changed, new scientific data appeared and approaches to understanding the problem continued to develop.
Objective – to evaluate maternal, perinatal and neonatal outcomes in the incidence of COVID-19 in the Khabarovsk Territory in the period from 2020 to 2021 [before the mass spread of Omicron strain SARS-CoV-2 (SARS-CoV-2 Omicron)].
Material and methods. A retrospective analysis of operational information for the entire period of COVID-19 morbidity in the Khabarovsk territory from March 11, 2020 to December 25, 2021 was carried out according to established reporting forms, including demographic indicators of the region and statistical data on COVID-19 for pregnant women, women in labor, women in labor, and children.
Results. For today, the most prominent negative outcomes of COVID 19 during pregnancy and puerperal period are premature birth and stillbirth. Medical premature termination of pregnancy is usually indicated in severely affected hypoxic mothers. Unfavorable neonatal outcomes from infected mothers are mainly caused by complications of prematurity and concomitant diseases. Taking into account the hypoxic and infectious origin of placental pathology, detected in placentas of COVID-19 – infected mothers, a possibility of long-term complications should be considered.
Conclusion. The perinatal period in COVID-19 is the period with the most unfavorable pregnancy outcomes for a mother-fetus couple, while newborns and young children are not at high risk of developing a severe course of COVID-19 infection.
Improvement of diagnostic measures in newborn babies born to mothers with syphilitic infection at the maternity hospital stage
Aim of the study. To consider the possibility of creating a modern model of organization of medical care for children born to women with syphilitic infection detected during this pregnancy or within five years before its onset, with a differentiated approach and choice of diagnostic tactics at the maternity hospital stage.
Material and methods. The paper analyzes the data of a comprehensive examination of 397 newborns included in the studies indicating the fact of birth by a woman with a documented history of syphilitic infection, and who were under observation from birth to 1 month of life for the period 2003–2020.
Results. A comparison of the results of serological reactions confirms the diagnostic significance of a combination of non-treponemal (RMP) and treponemal (RPGA and IgM and IgG ELISA), but the highest diagnostic significance is noted with a combination of direct and indirect diagnostic methods, which determines the need to introduce new diagnostic models aimed at optimizing laboratory studies of children born to women with syphilis during a real pregnancy or for three years before a real pregnancy.
Discussion. The model of medical care involves the improvement of a set of measures by optimizing laboratory diagnostics at the maternity hospital stage.
Conclusion. The introduction of the proposed modern model of organization of medical care for children born to women with syphilitic infection will provide a new modern approach to the choice of diagnostic tactics at the perinatal center/maternity hospital stage.
Practical aspects of management of newborn with venous thrombosis
The aim is to analyze clinical, laboratory, instrumental diagnostic methods, treatment tactics and management of newborn children of different gestation periods with thrombosis.
Material and methods. 65 newborn children with thrombosis were examined. Of these, 44 full-term and 21 premature babies. Thrombosis of various localization was detected in 22 children in the first and 43 children in the second weeks of life. The control group consisted of 31 full-term newborn babies and 20 premature babies without thrombosis.
Results. Venous thrombosis was detected in all observed children of the main group 65 (100%). The frequency of catheter-associated thrombosis in them was 50/65 (76.9%), but only 11/65 (16.9%) newborns developed clinical symptoms of thrombosis. Thrombosis without clinical manifestations occurred in 54/65 (83.1%) children. They were detected only during ultrasound examination. The most frequent localization of blood clots was thrombosis of the portal vein branches – in 46/65 (70.8%). Vascular thrombi of other localization were found in 19/65 (29.2%) of cases (thrombosis of the common iliac vein, including in combination with thrombosis of the femoral vein, renal veins, brachial vein thrombosis, and one child had a left atrial thrombus). Deficiency of natural anticoagulants was detected in 7/65 (10.8%) children with thrombosis. There was no statistically significant difference in hemostasis parameters of full-term and premature infants with thrombosis (p>0.05). There are no significant differences in these parameters in children with and without thrombosis. This proves once again that the low sensitivity of the traditional testing of coagulation to hemostasis disorders in children with thrombosis makes laboratory diagnostics uninformative. Approaches to therapy were determined by the localization of the thrombus, the degree of occlusion of the vessel, impaired function of damaged tissues, physiological features of hemostasis of newborns, pathological changes in it.
Conclusion. The introduction of ultrasound research methods into clinical practice has expanded the possibilities of diagnostic search in newborns with thrombosis and allowed them to be detected at the preclinical stage. All children from risk groups for the development of thrombosis are shown to have ultrasound with a doppler for early diagnosis and timely therapy of thrombosis.
Nutritional support for infants with cholestasis
Cholestatic liver disease in newborns and young children is a common cause of malnutrition. Many diseases have a chronic progressive course with the formation of biliary cirrhosis, liver failure and require early liver transplantation. Nutritional status is an important prognostic predictor of morbidity and mortality in patients both at the stage of waiting and after transplantation, which determines the importance of timely correction of the main macro- and micronutrients deficiency. Available literature data and our experience indicate the need to use a high-calorie diet with a high content of medium chain triglycerides, polyunsaturated fatty acids, protein, fat-soluble vitamins and minerals in this category of children.
The use of almond oil in skin care products for newborns
In this article we discusse the principles of assessing the condition of the skin of a newborn, describe the features of the skin of newborns, points out the factors influencing the occurrence of diseases and skin lesions, as well as the possibilities of their prevention. The composition and beneficial effect of sweet almond oil when used in infant skin care, relevant for neonatological and pediatric practice, are described in detail. The article presents recommendations aimed at further optimization of newborn skin care, especially in premature newborns and seriously ill children.
Transthoracic echocardiography of the double aortic arch in a newborn
Double aortic arch constitutes about 46–76% of all symptomatic congenital vascular rings, and usually appears in the first months of life. The vascular ring, formed by two functioning arches, tightly covers the trachea and esophagus, and is an absolute indication for surgical treatment at the time of diagnosis. Transthoracic echocardiography is considered practically uninformative in the diagnosis of vascular rings due to the limitation of the ultrasound window. The final diagnosis of a double aortic arch is carried out using other radiation methods of research. Our experience with newborns shows that the features of imaging in this period can allow us to verify the discussed pathology and detail the anatomy of the defect in order to answer key clinical questions and complete the diagnostic search. The article describes a clinical case of verification of a double aortic arch using transthoracic echocardiography in a newborn on the 1st day of life, which demonstrates the possibilities of ultrasound imaging of a double aortic arch with two functioning arches in the early neonatal period.
Respecting citizens’ rights in the field of health protection as a key responsibility of medical organizations. Part 2
In the second part of the material devoted to the observance of the rights of citizens in the field of health protection, the rights of patients to information, to compensation for harm to health, the practice of religious rites, as well as the rights of the patient to the admission of legal representatives, lawyers and clergy are considered.
Burnout among healthcare workers
The professional burnout syndrome of healthcare workers, it’s symptoms, risk factors and stages of burnout is described in the article as well as the ways of diagnostics in healthcare organization.
COVID-19 infection during pregnancy: risk of vertical transmission, fetal, and neonatal outcomes
The COVID-19 pandemic is a worldwide, critical public health challenge and is considered one of the most communicable diseases that the world had faced so far. Response and symptoms associated with COVID-19 vary between the different cases recorded, but it is amply described that symptoms become more aggressive in subjects with a weaker immune system. This includes older subjects, patients with chronic diseases, patients with immunosuppression treatment, and pregnant women. Pregnant women are receiving more attention not only because of their altered physiological and immunological function but also for the potential risk of viral vertical transmission to the fetus or infant. However, very limited data about the impact of maternal infection during pregnancy, such as the possibility of vertical transmission in utero, during birth, or via breastfeeding, is available. Moreover, the impact of infection on the newborn in the short and long term remains poorly understood. Therefore, it is vital to collect and analyze data from pregnant women infected with COVID-19 to understand the viral pathophysiology during pregnancy and its effects on the offspring. In this article, we review the current knowledge about pre-and post-natal COVID-19 infection, and we discuss whether vertical transmission takes place in pregnant women infected with the virus and what are the current recommendations that pregnant women should follow in order to be protected from the virus.
Is lung ultrasound helpful in COVID-19 neonates? – A systematic review
The SARS-CoV-2 infection has occurred in neonates, but it is a fact that radiation exposure is not recommended given their age.
The aim of this review is to assess the evidence on the utility of lung ultrasound (LUS) in neonates diagnosed with COVID-19.
Methods. A systematic literature review was performed so as to find a number of published studies assessing the benefits of lung ultrasound for newborns diagnosed with COVID and, in the end, to make a comparison between LUS and the other two more conventional procedures of chest X-rays or CT exam. The key terms used in the search of several databases were: “lung ultrasound”, “sonography”, “newborn”, “neonate”, and “COVID-190.
Results. In total, 447 studies were eligible for this review, and after removing the duplicates, 123 studies referring to LU were further examined, but only 7 included cases of neonates. These studies were considered for the present research paper.
Conclusion. As a non-invasive, easy-to-use, and reliable method for lung lesion detection in neonates with COVID-19, lung ultrasound can be used as a useful diagnosis tool for the evaluation of COVID-19-associated lung lesions. The benefits of this method in this pandemic period are likely to arouse interest in opening new research horizons, with immediate practical applicability.