Features of the clinical-metabolic and neurological status of children born from very early preterm birth at 38-40 weeks of postconceptual age: an observational study with a prospective assessment of outcomes
Despite the clear success of neonatology in the world, a high level of infant mortality and morbidity of premature children remains, and the risk of complications increases with increasing immaturity. The metabolic processes of adaptation of premature newborns that increase the risk of developing neurological abnormalities in premature babies with low and very low birth weight remain poorly understood. An integrative assessment of managed factors is necessary to determine the sequence and stages of medical care.
The aim of the study to establish the features of the clinical-metabolic and neurological status of children born from very early preterm birth (less than 32 weeks of gestation) at 38-40 weeks of postconceptual age.
Material and methods. A prospective cohort study of the clinical, metabolic, and neurological status of 30 children born before 32 weeks of pregnancy in the perinatal center of Khabarovsk was conducted using a typical sample. ECG, NSG, and General clinical blood tests were performed in these children in the early neonatal period and at 38-40 weeks, and the neonatal clinical risk index was determined.
Results. It was found that pregnancy of all women who gave birth to children at a gestation period of less than 32 weeks occurred in hypoxia and in all children, there were manifestations of asphyxia at birth, neurological symptoms both at birth and at 38-40 weeks of postconceptual age, and the main neurophysiological manifestations were manifestations of hypoxia and immaturity, a high index of neonatal clinical risk.
Conclusion. The main result of the study was the identification of features of the clinical and metabolic status of children born from very early preterm birth at 38-40 weeks of postconceptual age, which may be a reflection of the postnatal adaptation of immature children. Changes in neurological status during the first weeks of life should be dynamically evaluated, predictors of adverse subsequent cognitive and motor development should be identified, and used in the preparation of a program of habilitation and rehabilitation of children. The limitations of the study are related to a small sample and we plan to continue the study.
Endogenous markers for assessing the glomerular filtration rate in newborns and children of the first year of life
Dynamic assessment of the functional state of the kidneys in children with congenital anomalies of the kidneys and urinary tract is the main criterion for the development, progression of renal tissue remodeling processes, the effectiveness of anti-inflammatory therapy and surgical methods for restoring urodynamics. The main marker should be the glomerular filtration rate (GFR). The most reliable method for determining GFR is the method based on the clearance of exogenous markers. However, in children, especially in the first years of life, this method has not received widespread use due to its invasiveness and laboriousness of execution; therefore, GFR in children is usually assessed using the determination of the levels of endogenous markers such as creatinine, β-trace protein, β2-microglobulin, as well as the most promising at present - cystatin C.
The aim - to conduct a comparative analysis of the effectiveness of using serum cystatin C to determine the glomerular filtration rate in newborns and children of the first year of life with and without congenital anomalies of the kidneys and urinary tract.
Material and methods. The study included 66 newborns: with congenital anomalies of the kidneys and urinary tract (35 newborns) and without anomalies (31 newborns). The study excluded newborns with chromosomal diseases, treated with glucocorticosteroids, with congenital malformations of the cardiovascular system, with oncological diseases, with acute renal injury. All children underwent venous blood sampling to determine the levels of creatinine and cystatin C on the 4-6th day of life after the formation of the rate of diuresis; in the group of children with congenital anomalies of the kidneys and urinary tract, blood was taken again at the age of 3-7 months of life.
Results. In children with congenital anomalies of the kidneys and urinary tract included in the study (with diagnoses of megaureter, pyeloectasia, hydronephrosis, multicystic, autosomal recessive polycystic disease), no decrease in renal function was observed in the neonatal period. The glomerular filtration rate, calculated on the basis of creatinine at 4-6 days of life, was determined below the standard indicators (21.0-32.3 ml/min/1.73 m2), which could lead to an erroneous interpretation of the situation as impaired renal function with an incorrect definition stages of chronic kidney disease. At the same time, the glomerular filtration rate, determined using the concentration of cystatin C, was within the standard values. After 3-7 months, creatinine GFR correlates to a greater extent with cystatin C GFR, but it can also cause overdiagnosis of decreased renal function.
Conclusion. To assess GFR in children of the first year of life (especially in newborns in the first week of life), it is recommended to use formulas that uses serum cystatin C.
The phenotype of a newborn with diabetic fetopathy
Gestational diabetes mellitus (GSD) is a disease characterized by moderate hyperglycemia, first detected during pregnancy and does not meet the criteria for «manifest» diabetes mellitus (DM).
The aim of the sudy was to determine the main criteria for the diagnosis of the "diabetic fetopathy" symptom complex, and to establish the frequency of these criteria in newborns born to women with diabetes.
Material and methods. The retrospective study included 1579 pregnant women aged 21 to 42, who had diabetes and had given birth to children between 2014 and 2017. We analyzed medical documentation.
Results. 53.6% newborns had various problems of neonatal period, and 12 children were diagnosed with diabetic fetopathy (0.76%). Compensation for DM during pregnancy can explain the low incidence of diabetic fetopathy in the group of children born to these mothers. Most often, the diagnosis of diabetic fetopathy was in children from mothers with GSD (11 out of 12 children). The frequency of diabetic fetopathy in children did not depend on the age of the mothers.
Conclusion. Morbidity and mortality in newborns can be reduced by carefully monitoring blood glucose levels throughout pregnancy, as well as at the planning stage.
First experience of neonatal near miss assessment in the Federal district: analysis, results, and prospects in the Far Eastern Federal district
Most (75%) neonatal deaths occur in the first week of life (WHO, 2020), the early neonatal mortality rate (ENM) is most comparable to the neonatal near miss (NNM). Neonatal near miss are newborns who almost died but survived after overcoming serious complications during pregnancy, childbirth, or during the first 7 days of extrauterine life. By identifying the structure of the NNM, you can assess missed opportunities and improve the system of medical care for children.
Purpose - to study the frequency and structure of pathological conditions of neonatal near miss in the Far Eastern Federal district, to assess the prospects for evaluating the indicator.
Material and methods. Retrospective analysis of the causes of NNM cases in 6 out of 10 subjects of the far Eastern Federal district based on medical documents, Rosstat data and statistical accounting forms No. 32 in the period 01.01.2017-31.12.2019. Selection criteria: birth weight less than 2500 g in full-term pregnancy; Apgar score at 5 minutes less than 7 points; ventilator in the first 7 days of life; congenital infection; obstetric near miss. The coefficients of early neonatal mortality (ENM) and infant mortality (IM) by subject were taken into account.
Results. The higher the NNM value in the region, the Lower the ENM indicators. Thus, NNM was minimal for all the studied parameters in the Jewish Autonomous region (JAR), but the RNS and IM indicators had the maximum values relative to other studied territories. High NNM indicators demonstrate the effectiveness of the efforts of the maternity service in overcoming life-threatening conditions in newborns, directly affecting mortality rates. Comparison of the ENM, ENM, and NNM indicators showed that there is a reserve for managing perinatal losses as another mechanism for improving the demographic situation.
Conclusion. The analysis of NNM cases makes it possible to differentiate planned, iatrogenic and organizational causes of severe outcomes for newborns and to carry out preventive targeted measures to reduce perinatal losses.
Impact of mechanical ventilation on haemodynamic in neonate
This review presents the main physiological principles of cardiorespiratory relationships during spontaneous respiration and in conditions of positive pressure ventilation. The characteristic of systemic and intrapulmonary hemodynamics is given. A systematic approach is presented to minimize the negative effects of positive pressure on the hemodynamic status of a newborn during mechanical ventilation.
Early visual experience and its role in the development of a child
The function of the visual analyzer plays one of the Leading roles in the development of the child. From the first days of a child's life, vision is closely associated with touch, hearing, smell and other types of sensitivity. As a result, complex dynamic systems of connections are formed, which are the sensory basis of all mental activity and orientation of the child in space.
Understanding the processes and creating optimal conditions for early neuro-sensory development is important both for caring for a healthy newborn and young child, and for organizing developmental care for premature and sick children in a hospital setting.
The newborn is able to recognize contrasting images (faces and eyes), which are rounded and easier to observe, since their eye muscles have not yet had much practice in making sudden movements. The visual apparatus of a premature newborn has additional functional limitations and points of vulnerability.
The article discusses aspects of the visual system in the neonatal period, with a more detailed analysis of the features associated with prematurity, describes the mechanisms explaining the negative impact on the processes of visual development of intense direct light, the absence of objects and patterns in focus, lack of attention (for example, sedation), lack of changes in the environment, lack of movement, complete darkness, or lack of adequate lighting on waking.
A long period of nursing a premature baby in a hospital in the intensive care unit, in an incubator microclimate in compliance with a protective regime, the impossibility of full maternal care, and therefore in the absence of sensitive stimuli, falls on the most important period of the development of the nervous system. It is at this age that an adequate and timely start of neurosensory development is very important, in connection with which the need for research is increasing to determine the optimal start dates and methodology for early developmental care.
Congenital cytomegalovirus infection: current challenges and possible solutions
Congenital cytomegalovirus (CMV) infection is often associated with severe neurological damage, increased neonatal mortality, neurocognitive disorders, hearing loss and functional impairment in children. In the current article we present the incidence of congenital CMV based on the official statistics and actual figures, as well as clinical characteristics and algorithms for laboratory diagnosis of congenital and intranatal CMV. The management of CMV during pregnancy and active CMV in newborns is also discussed. Finally, we discuss the indications for administration of intravenous CMV immunoglobulin in pregnant women and newborns and valganciclovir in suspension in newborns, infants and young children.
Legal aspect of the doctor's responsibility for the patient's health
The article describes the Legally established rights and obligations of the attending physician, as well as other medical professionals who provide medical care to patients, and also defines the rights and obligations of the patient and his Legal representatives to take care of their health, as well as their responsibility for noncompliance with the doctor's prescriptions and recommendations.
Coronavirus infection in neonates: a systematic review
Aim. To summarise currently reported neonatal cases of SARS-CoV-2 infection.
Methods. A search strategy was designed to retrieve all articles published from 1 December 2019 to 12 May 2020, by combining the terms 'coronavirus' OR ('covid' OR 'SARS-CoV-2') AND ('neonat*' OR 'newborn') in the following electronic databases: MEDLINE/PubMed, Scopus, Web of Science, MedRxiv, the Cochrane Database of Systematic Review and the WHO COVID-19 database, with no language restrictions. Quality of studies was evaluated by using a specific tool for assessment of case reports and/or case series.
Results. Twenty-six observational studies (18 case reports and 8 case series) with 44 newborns with confirmed SARS-CoV-2 infection were included in the final analysis. Studies were mainly from China and Italy. Half of neonates had a documented contact with the infected mother and one out of three infected neonates was admitted from home. Median age at diagnosis was 5 days. One out of four neonates was asymptomatic, and the remaining showed mild symptoms typical of acute respiratory infections and/or gastrointestinal symptoms. The majority of neonates were left in spontaneous breathing (room air) and had good prognosis after a median duration of hospitalisation of 10 days.
Conclusion. Most neonates with SARS-CoV-2 infection were asymptomatic or presented mild symptoms, generally were left in spontaneous breathing and had a good prognosis after median 10 days of hospitalisation. Large epidemiological and clinical cohort studies, as well as the implementation of collaborative networks, are needed to improve the understanding of the impact of SARS-CoV-2 infection in neonates.
Transplacental transmission of SARS-CoV-2 infection
SARS-CoV-2 outbreak is the first pandemic of the century. SARS-CoV-2 infection is transmitted through droplets; other transmission routes are hypothesized but not confirmed. So far, it is unclear whether and how SARS-CoV-2 can be transmitted from the mother to the fetus. We demonstrate the transplacental transmission of SARS-CoV-2 in a neonate born to a mother infected in the last trimester and presenting with neurological compromise. The transmission is confirmed by comprehensive virological and pathological investigations. In detail, SARS-CoV-2 causes: (1) maternal viremia, (2) placental infection demonstrated by immunohistochemistry and very high viral load; placental inflammation, as shown by histological examination and immunohistochemistry, and (3) neonatal viremia following placental infection. The neonate is studied clinically, through imaging, and followed up. The neonate presented with neurological manifestations, similar to those described in adult patients.