Неонатология № 4 (34), 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
4 . 2021
Hemodynamic and hematological disorders in newborns
Content
Editorial

Editorial

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In memory of professor Erich Zaling

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Original researches

Acute kidney injury in premature infants: frequency, clinical features, associated factors and conditions

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The difficulty in diagnosing acute kidney injury (AKI) in premature infants is due to the absence of specific symptoms of AKI, the presence of a nonoliguric AKI variant, and the lack of a common understanding of the normal concentration of serum creatinine depending on gestational and postnatal age.

The aim was to determine the frequency and clinical features of AKI in premature infants.

Material and methods. A retrospective and observational prospective study was carried out, which included clinical, laboratory and ultrasound examination of premature infants born at the National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov (Center). The retrospective study included 459 preterm infants born at the Center in 2018 and admitted to the ICU from the maternity back. The prospective study included 80 preterm infants who needed treatment in the ICU. The children were divided into 2 groups. Group 1 included 60 premature babies without AKI, group 2 - 20 premature babies with AKI. The groups were comparable for birth weight and gestational age.

Results. The incidence of AKI in premature infants treated in the ICU was 6.5%. The incidence of AKI increased with decreasing gestational age and was the highest (71%) in the group of children with gestational age less than 28 weeks. Among the forms of AKI, there was an early form (60%) and a late form (40%). It was noted that the development of AKI significantly increased the risk of a poor prognosis. Among children who had such a complication as AKI, death occurred in 36.7%. Grade 2-3 intraventricular hemorrhages and periventricular leukomalacia were 6 times more common in children with AKI. The presence of fetal transfusion syndrome in multiple pregnancies increased the risk of AKI by 3.27 times (95% CI 0.98-10.93). Among diseases and conditions of the early neonatal period, congenital pneumonia (p=0.004), circulatory failure (p<0.001) and hemodynamically significant functioning ductus arteriosus (p=0.046) were significant for the development of AKI. In children who required high frequency mechanical ventilation, traditional mechanical ventilation and cardiotonic therapy in the early neonatal period, AKI developed much more often (p<0.001). The use of nephrotoxic drugs (Gentamicin and Vancomycin) was significantly more common in the group of children with AKI; the majority had their consistent appointment: 17 (85%) vs 30 (50%) (p=0.045).

Conclusion. The factors that increased the risk of AKI in preterm infants include: congenital pneumonia, hemodynamically significant patent ductus arteriosus, impaired central hemodynamics, respiratory and cardiovascular insufficiency, requiring mechanical ventilation and cardiotonic therapy, as well as the use of nephrotoxic drugs. AKI in premature infants is characterized by the presence of early and late forms, oliguric and non-oliguric variants. Grade 2-3 intraventricular hemorrhage and periventricular leukomalacia are diseases that are often (in 45%) associated with AKI in a premature baby.

Analysis of the course of retinopathy of prematurity in the Republic of Mordovia

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Objective. To analyze the course of retinopathy of prematurity (RP) in children with extremely low body weight (ELBW) and very low body weight (VLBW) in Mordovia.

Material and methods. A retrospective analysis of 202 patients charts at with gestational age 20-32 weeks, born in 2014-2020, was carried out at the Mordovia Regional Clinical Hospital of Mordovia (Saransk). Children with retinopathy of prematurity (ROP) were divided into two groups: the main group, divided into two subgroups: the 1st - premature babies with ELBW (n=39) and the 2nd - children with VLBW (n=63). And the control group (premature babies without retinopathy), also divided into two subgroups: ELBW (n=25) and VLBW (n=75). The results were processed using the statistical program Statistica 10.0.

Results. Children with ELBW with retinopathy in 100% of cases were born at a term of less than 30 weeks. In children with VLBW such children - 76%. In the group of children with ELBW and VLBW with retinopathy, significant factors are chronic placental insufficiency (CRF) (F - 0.95 and 0.92) and a history of miscarriages (F - 0.91 and 0.93). Children with ELBW in both groups quite often received red blood cell transfusions 4 or more times. In both groups of children with ELBW (58.9 and 48%), the patent ductus arteriosus functioned. The duration of respiratory support in children with both ELBW and VLBW in most cases did not exceed 10 days.

Conclusion. Significantly more often children with VLBW in the main group received more than 4 blood transfusions - 33.3% (p<0.05). In children with ELBW, stage II RP was more often observed (59.2%), in children with VLBW - in stage I (66.7%). In children with ELBW in both groups (97.4 and 92%, respectively), prematurity anemia prevailed.

Rewiews

Diagnostics and treatment of chronic heart failure in newborns

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The article presents a modern view on the basic principles of diagnosis and treatment of heart failure in newborns and premature babies. The current criteria for interpretation of results of additional laboratory methods for monitoring the degree of heart failure in newborns (NT-proBNP) are described. The principles and algorithms for the management of newborns and premature infants with heart failure are presented.

Prediction of the intensity of postnatal hemolysis in newborns with hemolytic disease by the Rh-factor, who received intrauterine transfusion of donor erythrocytes

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Currently, intrauterine transfusion (IUT) is the standard of treatment for severe forms of fetal hemolytic disease (HDF). Owing to this method, in recent years, there has been a significant decrease in the incidence of severe forms of Rh-mediated hemolytic disease of the newborn (HDN). It changes the HDF pathogenesis, allowing the continuation of the pregnancy, and besides this significantly affects the postnatal picture of the disease. In this connection it's necessary to determine the most informative predictors of the intensive postnatal hemolysis which would allow to predict the severity of HDN and choose the optimal neonatal treatment after IUTs. Literature analysis has shown that there are several criteria: antenatal (assessment of antibody cytotoxicity, amount of IUTs, bilirubin level at the last IUTs) and postnatal criteria (fetal hemoglobin fraction, reticulocytes level in peripheral blood, and direct Coombs' test after birth). The most informative and clinically available predictors are the fetal hemoglobin fraction of more than 40-50%, determined by Kleinhower-Betke test or an automatic blood analyzer; the reticulocyte count of >100x109 and a positive direct Coombs' test after birth.

Nutritional strategies to prevent necrotizing enterocolitis in preterm neonates

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Management of enteral feeding in very preterm infants is extremely challenging for neonatogists. Feeding strategies are fundamental for preventing necrotizing enterocolitis, normal growth and development of preterm infants, including neurodevelopmental outcomes. This review presents current trends and principles of enteral nutrition of preterm infants.

Review of the most contentious issues of breast milk fortification in preterm infants

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The introduction and use of breast milk enrichment techniques in the practice of a neonatologist is one of the main aspects of successful nursing of deeply premature infants. Currently, the subject of discussion is which method of fortification is the most effective and safe, whether there is a need to enrich breast milk after discharge of a premature baby and what to do in case of postnatal growth disorder in a premature baby receiving a nutrient subsidy by the standard method of enrichment. These issues are the subject of discussion of the presented review.
Clinical practice guidlines

Congenital anemia due to fetal blood loss (guideline)

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The article presents the guideline of management of the newborns with congenital anemia due the fetal blood loss: definition, etiology, diagnostics and treatment of this disease with evidence based practice, algorithm of management and health care quality criteria.

Lawyer column

Rules for issuing medical documents on birth and death: novellas 2021

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The article discusses the new provisions of Legislation on the issuance of medical documents on birth and death in connection with the already existing regulatory Legal acts on the criteria of Live birth, on acts of civil status and on the regulatory regulation of the issuance of bodies of the deceased for burial.

International practice

Recognition and management of neonatal hemodynamic compromise

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Hemodynamic compromise of the neonate can occur in various clinical situations, including but not limited to maladaptation during the early transitional period, sepsis, congenital heart anomalies, hemodynamically significant patent ductus arteriosus, persistent pulmonary hypertension of the newborn, systemic inflammatory diseases such as necrotizing enterocolitis, and dehydration.

Despite the handful of advances in neonatal care through ground-breaking clinical trials, the management of neonatal shock is often dependent on the bedside clinician's experience and training without the aid of high-level evidence. However, the recognition for the importance of comprehensive and serial hemodynamic assessment is growing. There is now a wealth of literature investigating the use of functional echocardiography, nearinfrared spectroscopy, and noninvasive impedance-based cardiometry to complement common bedside hemodynamic measures such as blood pressure and heart rate measurement.

In this review article, the pathophysiology of neonatal hemodynamic compromise is outlined, and concomitant best-evidence management for hemodynamic compromise in the neonate is proposed.

News of Cochrane database

News of Cochrane database (# 4, 2021)

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Neonatology news

News of neonatology (# 4, 2021)

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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
Оргздрав-2022. Эффективное управление в здравоохранении
РОСМЕДОБР 2021
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