Perinatal brain injure in premature infants with congenital pneumonia: computer analysis of risk factors by the decision tree method
Perinatal brain injury of the nervous system in newborns is one of the most pressing problem in neonatology. The premature newborns are the highest risk groups. The leading risk factors for the development of perinatal brain injury, in preterm infants with congenital pneumonia are: complicated pregnancy, severe asphyxia during childbirth, respiratory and cardiovascular insufficiency. The earlier the newborn is born, the higher is the probability of a combination of several factors leading to perinatal brain injury
The aim – comprehensive analysis of risk factors for the development of perinatal brain injury in preterm infants with congenital pneumonia
Material and methods. Retrospective observational clinical study was conducted in January 2017 to February 2019 in National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Ministry of Healthcare of the Russian Federation. 194 children with congenital pneumonia were enrolled and divided into 2 groups: 1 group (n=88) – premature infants with gestation age (GA) 22–36 weeks with perinatal brain injury; 2 group (n=106) – premature infants of similar GA, without perinatal brain injury. An assessment of multiple organ failure was determined according to 7 criteria of the modified NEOMOD scale (moderate dysfunction ≤4 points, an average dysfunction – 5–7 points and severe ≥8 points).
Results. All children with severe multiple organ failure had the highest risk of developing perinatal brain injury, regardless of other risk factors. In children with average severity of multiple organ failure the highest risk of perinatal brain injury damage was found in children with GA less than 28 weeks and who had invasive ventilation. In children with moderate severity of multiple organ failure, the risk of developing a perinatal brain lesion was associated with Apgar 1 minute after birth.
Conclusion. The relationship between the severity of infectious disease, GA, frequency and severity of perinatal brain injury was clarified and an algorithm for predicting perinatal brain lesions in premature infants with congenital pneumonia was developed in our study. The most significant risk factors for perinatal brain injury in newborns were GA less than 28 weeks, low Apgar score at 1 minute of life and severe multiple organ failure.
Pathomorphological features of brain injuries depending on gestational age
Brain injuries can develop in newborns with different perinatal disorders and are one of main causes of mortality.
Objective. To investigate the pathomorphological features of brain injuries in newborns different gestational age (GA) with severe perinatal disorders treated in NICU and died in neonatal period.
Methods. We analyzed 89 pathomorphological examinations. 39 of them were examinations of newborns GA 27 wks’ or less, 24 examinations – GA 28–31 wks’, 4 – GA 34–36 wks’ and 18 examinations – 37–41 wks’.
Results. The main pathological conditions leading to death in newborns treated in NICU were neonatal infections and congenital malformations. Our data shows that bacterial sepsis (EOS) and pneumonia were significantly more common in newborns with a smaller GA. Hemorrhagic brain injury was observed in 75% of very preterm infants, that in 3 times more often than in preterm infants GA 32–34 wks’ and in 2.3 times more often than in term infants. Hemorrhagic brain injury was observed in 100% of preterm infants GA 24 wks’ and combined hemorrhagic brain injury was in 57.2%. Of special note is that very preterm babies GA 27 wks’ had the lowest percentage of hemorrhagic injury both isolated and combined.
Conclusion. Early onset infections and congenital malformations are the main factors affecting the brain injuries. The most common brain damage in deceased newborns GA 31 wks’ or less were the intraventricular hemorrhage varying degrees if severity with progressive hemorrhage in III, IV ventricles and posterior cranial fossa.
Russian innovative device for feeding children with expressed milk or milk formula
A new device for feeding newborns (the nozzle of Dr. Schneiderman), created at the National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of Ministry of Health of Russian Federation, is a convenient and comfortable alternative way of feeding a newborn baby with expressed milk or ilk formula of children who can not or for some reason cannot suck directly from the chest. The device is an important tool in the clinical practice of a neonatologist, breast-feeding consultant, baby nurse and nursing mother, which allows to increase the percentage of successful breast-feeding.
Methods for predicting ductus arteriosus persistence in preterm infants (literature review)
The literature review is devoted to the analysis of various approaches to predicting the long-term persistence of a hemodynamically significant arterial duct in deeply premature newborns. A detailed description of methods based on the evaluation of objective examination data, as well as clinical, echocardiographic and biochemical parameters in this category of patients, taking into account the accuracy of the prognosis, specificity and sensitivity, is given.
SAFE-R+ ultrasound protocol in the medical practice of intensivist of neonatal intensive care unit
Rapid diagnosis of sudden and life-threatening conditions in the neonatal intensive care unit (NICU) is important for the timely initiation of therapy. Recently, the use of ultrasound as a tool for the implementation of a program for the timely verification of pathological conditions of newborns has become widespread in clinical practice. In the modern literature, various protocols of bedside ultrasound diagnostics (ultrasound diagnostics) – Point – of-Care Ultrasound (POCUS) – used in adult patients, in particular BLUE, FAST, RUSH, etc. are well described. At the same time, the choice of specialized protocols developed specifically for newborns is small (SAFE, SAFE-R).
The team of authors supplemented the existing protocols of emergency diagnostics of the condition of newborns, as a result of which a domestic ultrasound protocol (SAFE-R+) was created. The new diagnostic scheme is specially designed for use by specialists of the NICU and field resuscitation and advisory teams. The main features of SAFE-R+ are represented by the use of standardized ultrasound positions, a single sensor, as well as the effectiveness of diagnosing emergency conditions of newborns by a doctor who has even a minimal amount of training in ultrasound diagnostics.
Respecting citizens’ rights in the field of health protection as a key responsibility of medical organizations. Part 1
The article discusses the key provisions of Federal Law No. 323-FZ dated 21.11.2011 “On the basics of public health protection in the Russian Federation”, defining the rights of citizens in the field of health protection, the procedure and methods of their implementation, as well as analyzes the responsibility of medical organizations for their violation and statistical data for 2020–2021.
Bad news announcement
The article presents analysis of patients’ reactions depending on the way how did «bad news» were reported by doctor, in particular about child’s death.
The preparation procedure for a difficult conversation as well as the structure of child’s death report is shown in the article.
Hypotension in Preterm Infants (HIP) randomised trial
Objective. To determine whether restricting the use of inotrope after diagnosis of low blood pressure (BP) in the first 72 hours of life affects survival without significant brain injury at 36 weeks of postmenstrual age (PMA) in infants born before 28 weeks of gestation.
Design. Double-blind, placebo-controlled randomized trial. Caregivers were masked to group assignment.
Setting. 10 sites across Europe and Canada.
Participants. Infants born before 28 weeks of gestation were eligible if they had an invasive mean BP less than their gestational age that persisted for ≥15 min in the first 72 hours of life and a cerebral ultrasound free of significant (≥ grade 3) intraventricular haemorrhage.
Intervention. Participants were randomly assigned to saline bolus followed by either a dopamine infusion (standard management) or placebo (5% dextrose) infusion (restrictive management).
Primary outcome. Survival to 36 weeks of PMA without severe brain injury.
Results. The trial terminated early due to significant enrolment issues (7.7% of planned recruitment). 58 infants were enrolled between February 2015 and September 2017. The two groups were well matched for baseline variables. In the standard group, 18/29 (62%) achieved the primary outcome compared with 20/29 (69%) in the restrictive group (p=0.58). Additional treatments for low BP were used less frequently in the standard arm (11/29 (38%) vs 19/29 (66%), p=0.038).
Conclusion Though this study lacked power, we did not detect major differences in clinical outcomes between standard or restrictive approach to treatment. These results will inform future studies in this area.