Неонатология № 1 (31), 2021

Neonatology

News, Opinions, Training

The journal is published in collaboration with All-Russian Public Organization for Assisting Development of Neonatology «Russian Society of Neonatologists»

The journal is intended to become a guide for medical practitioners being a part of the continuing medical education of physicians in Russia.


Topic number
1 . 2021
A year with COVID-19: first results
Content
Editorial

Can SARS-COV-2 virus be considered as a causative agent of TORCH infections in newborn babies?

Annotation

Currently there is no clear understanding of COVID-19's place in structure of antenatal and perinatal mortality. Number of carefully documented cases of congenital infection with proven SARS-CoV-2 etiology in literature sources is within a hundred of clinical observations. Also, it has not yet been studied whether perinatal contact with new coronavirus has an adverse influence on child's health in the remote future, since abnormality of early neonatal adaptation in children whose mothers had COVID-19 shortly before childbirth, in most cases, manifest themselves in a mild form, and most commonly physicians cannot find confirmed by PCR assay of SARS-CoV-2 RNA in children. Prospective multicenter clinical trials are already underway in a number of countries to answer all the questions.

Original researches

Acute kidney injury in newborns treated in intensive care units: results of a multicenter study

Annotation

According to the current literature, every third patient of the neonatal intensive care unit (NICU) has a decrease in renal function, with a general heterogeneity of this group.

The frequency of acute kidney injury (AKI) may differ significantly in the study of individual groups of newborns (sepsis, asphyxia, cardiac surgery, premature infants, etc.).

The aim of this study was to compare the frequency of AKI in newborns treated in NICU of various profiles, as well as to establish the distinctive features of risk factors for AKI development.

The study involved structural divisions of maternity clinics, perinatal centers and children's hospitals, taking into account the routing of newborns in the Russian Federation.

Material and methods. The prospective cohort study included 851 newborns from 20 NICUs, of which: the NICU of maternity clinics - 47.9%, the NICU of large perinatal centers - 7.9%, the ICU for newborns and premature infants - 13.6%, the NICU for newborns with surgical pathology - 28.9%, the Kulakov Obstetrics, Gynecology and Perinatology National Medical Research Center of Ministry of Healthcare of the Russian Federation -1.6%. The study included all newborns treated in the NICU (from 0 to 28 days of life) and having at least 2 biochemical blood tests to determine the level of serum creatinine with intervals between tests of 48-168 hours. Assessment of the severity of AKI was carried out on a scale kidney disease improving global outcomes (2017).

Results. According to our data, the frequency of neonatal AKI among NICU patients is 22.7%. At the same time, the frequency of AKI development relative to different NICU profiles was comparable. According to our data, the manifestation of AKI episodes in most cases (80.3%) was recorded in the first week of postnatal life. Among the risk factors for AKI, prematurity and surgery had a significant impact. We noted the relationship between the specifics of the NICU and the risk factors of AKI. Thus, among the NICUs of maternity hospitals, the Apgar score was a statistically significant risk factor for AKI, while in the NICU of children's hospitals, there was a correlation between episodes of AKI and pathological weight gain.

Conclusion. The AKI in newborns receiving treatment in the NICU Largely depends on the underlying disease, and, accordingly, the profile of the department. The most important in relation to the development of AKI is the first week of life. Special attention should be paid to the excretory function of the kidneys in premature newborns, surgical patients, and children who have suffered asphyxia in childbirth. By itself, the development of an AKI episode had a significant impact on the average duration of hospitalization, including in the NICU.

Predicting outcomes of congenital diaphragmatic hernia by calculating liver herniation derives

Annotation

Objective - to assess relationship between degree of liver herniation and mortality rate in postnatal period.

Material and methods. Prospective study included 71 pregnant women at 18 weeks gestational age with congenital diaphragmatic hernia according to ultrasound data. All woman underwent MRI with calculation percent of liver herniation and liver to thorax ratio. Liver and thorax volume was measured on T2WI by manually tracing region of interest and summing selected areas. All structures of thoracic cavity (except spine) were included. Percent liver herniation was defined as ratio of liver displacement volume (volume of liver located inside the chest) to the total liver volume.

Results. Among survivors significantly lower degree of liver herniation and liver to thorax ratio were observed - 7.54 (0-9.84) and 4.76 (0-5.97) respectively (p<0.001). Corresponding indicators for deceased were 20.07 (3.99-31.85) and 14.91 (2.28-22.94). Area under the curve for liver to thorax ratio was 0.766, for liver herniation - 0.767. Among survivors weak positive correlation was found between degree of liver herniation and liver to thorax volume with rate of using biodegradable material for plastic diaphragm defect (r=0.345, p=0.038 and r=0.389, p=0.018, respectively). Among deceased weak negative correlation with number of days at the time of death was revealed (r=0.357, p=0.035 and r=0.349, p=0.039, respectively).

Conclusion. Data obtained allow to use liver herniation derives as predictors of poor prognosis in cases of congenital diaphragmatic hernia.

The use of computer vision technologies for an objective assessment of indicators of concentration of attention in newborns and infants with visual stimulation for the purpose of developmental care

Annotation

Assessment of visual function in the first few days after birth is mainly limited to the study of eye movements, the ability to fix a gaze and follow an object. In order to determine how the child's gaze moves when examining an object, how long it is fixed on the object, techniques are needed that allow recording the movements of the eyeballs and determining the trajectory of the gaze.

The aim of the study was to develop a method based on machine learning technology and computer vision for automated analysis of eye movement and fixation of the gaze of a newborn and an infant during visual stimulation.

Material and methods. The proposed method includes video filming of newborns and children in the first year of life in a hospital and outpatient. Video recordings from mobile phone cameras with a length of 15 seconds to 3 minutes were used as the initial data. 73 video files were selected from 150 videos of newborns, of which 61 recordings of sufficient quality were selected, in which the child was recognized in at least 30% of frames. For each of the 61 recordings, a neonatal visual stimulation track was recorded. Facial recognition was implemented using a widely used pre-trained model based on machine learning and ultra-precise networks. The eye movement research algorithm includes face search, determination, head position by the location of the eyes, nose, lips, eye area search, pupil search, relative gaze determination and absolute gaze direction determination, and blink tracking.

Results and discussion. A neural network was developed and trained for recognizing facial images of newborns and infants and for locating the eyes on a child's face. The method made it possible to receive data on the direction of the child's gaze in real time using the camera of an ordinary smartphone or a simple web camera. Depending on the size of the displayed image and the distance to it, the system calculates the total time of concentration on the image, and also detects moments when the child is not interested in the image.

Conclusion. The proposed method can be used to analyze the effectiveness of early visual stimulation in children, in the context of long-term effects on psychomotor and cognitive development, as well as to objectify data from various programs for early assessment of visual function in newborns and infants.

Rewiews

Acute kidney injury in premature newborns (literature review)

Annotation
The problem of acute kidney injury (AKI) in newborns remains relevant, despite the development of modern technologies and the introduction of new methods of treatment. In most cases, AKI in newborns develops because of septic processes, severe hypoxic damage or exposure to drugs with a potentially nephrotoxic effect. Premature infants are more susceptible to AKI than other infants, because of reduced number of nephrons due to incomplete nephrogenesis. This literature review discusses the incidence, etiology, and pathogenesis of AKI in premature infants of different gestational age, risk factors for AKI in premature infants, diagnostic methods for AKI, and principles of nursing children with AKI.

Infant colic: a new look at pathogenetic mechanisms and therapeutic measures (literature review)

Annotation

The article represents a review of the current literature on infant colic topic from the point of view of the recommendations of the IV Roman Criteria, reflecting the opinion of the World's leading experts - pediatricians, gastroenterologists, allergists. Infant colic refers to functional disorders of the gastrointestinal tract and is characteristic to infants up to 5 months of age. The key point in the diagnosis of infant colic is the exclusion of organic pathology ("red flags"), which is normally no more than 5%. The article discusses in details the current ideas concerning the pathogenetic mechanisms of infant colic and the modern principles of their correction based on these data from the point of view of evidence-based medicine. Correcting the symptoms of infant colic includes psychological support for the family, maintaining breastfeeding and the use of probiotics (Lactobacillus reuteri DSM17938), the efficiency of which has only been proven in breastfed babies. If breastfeeding is not possible, preference is given to partially hydrolyzed whey mixtures with reduced lactose content and enriched with prebiotics.

Lawyer column

Off-label therapy in neonatology

Annotation

The article examines the modern legal basis for the use of medicines "out of the instructions" (off-label therapy), foreign experience in regulating off-label prescriptions, as well as the necessary conditions for its appointment in the Russian Federation.

International practice

Echocardiographic diagnosis and hemodynamic evaluation of patent ductus arteriosus in extremely low gestational age newborn (ELGAN) infants

Annotation

Persistent Patent ductus arteriosus (PDA) is a common finding in extremely low gestational age newborn infants and its prevalence is inversely proportional to the gestational age. The presence of a persistent PDA is associated with increased mortality and several significant morbidities including intraventricular hemorrhage, pulmonary hemorrhage, necrotizing enterocolitis, and chronic lung disease or bronchopulmonary dysplasia. However, treating PDA has not been demonstrated to have beneficial impact on the long term outcomes. Currently there is no consensus on whether to treat the PDA or not, and if treat, when to treat and how to treat. The echocardiography is the investigation of choice to diagnose PDA, estimating the magnitude of shunt volume and assessing its hemodynamic significance, and to exclude/diagnose any associated congenital heart defect before any intervention. Various echocardiographic parameters and staging/scoring systems have been described to help the clincians making the clinical decisions and some of theses scoring systems are quite complex to apply in a busy day to day clinical practice. This concised review paper is focused to help the clinicians in making a clinical decision based upon clincial and echocardiography parameters. Hence, only the parameters which are commonly used and helpful inmaking the clinical decisions in day to day clincial practice have been described in this paper.

Optimizing hemodynamic care in neonatal encephalopathy

Annotation

Hemodynamic impairment occurs in up to 80% of infants with neonatal encephalopathy (NE). Not all infants benefit from therapeutic hypothermia (HT); there are some indications that the trajectory of brain injury might be modified by neurologic monitoring and early management over the first 72-h period. It is also possible that optimizing hemodynamic management may further improve outomes. The coupling between cerebral blood flow and cerebral metabolism is disrupted in NE, increasing the vulnerability of the newborn brain to secondary injury. Hemodynamic monitoring is usually limited to blood pressure and functional echocardiographic measurements, which may not accurately reflect brain perfusion. This review explores the evidence base for hemodynamic assessment and management of infants with NE while undergoing HT. We discuss the literature behind a systematic approach to a baby with NE with the aim to define best therapies to optimize brain perfusion and reduce secondary injury.

Synthesis and systematic review of reported neonatal SARS-CoV-2 infections

Annotation

A number of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections have been reported in neonates. Here, we aim to clarify the transmission route, clinical features and outcomes of these infections. We present a meta-analysis of 176 published cases of neonatal SARS-CoV-2 infections that were defined by at least one positive nasopharyngeal swab and/or the presence of specific IgM. We report that 70 and 30% of infections are due to environmental and vertical transmission, respectively. Our analysis shows that 55% of infected neonates developed COVID-19; the most common symptoms were fever (44%), gastrointestinal (36%), respiratory (52%) and neurological manifestations (18%), and lung imaging was abnormal in 64% of cases. A lack of mother-neonate separation from birth is associated with late SARS-CoV-2 infection [OR 4.94 (95% CI: 1.98-13.08), p=0.0002; adjusted OR 6.6 (95% CI: 2.6-16), p<0.0001], while breastfeeding is not [OR 0.35 (95% CI: 0.09-1.18), p=0.10; adjusted OR 2.2 (95% CI: 0.7-6.5), p=0.148]. Our findings add to the literature on neonatal SARS-CoV-2 infections.

News of Cochrane database

News of Cochrane database (# 1, 2021)

Annotation
Neonatology news

News of neonatology (# 1, 2021)

Annotation
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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