Neonatology

Current area of research is the study of a risk factors, formation of mechanisms, and clinical features of hypophosphatemia in premature infants in order to develop new approaches to screening, prevention and the early correction.

Aim. To study the clinical aspects of hypophosphatemia in very premature infants.

Material and methods. The study included premature infants of gestational age 24/0–31/6 weeks (n=84). The subjects were divided into an observation group (n=49; 58.3%) and a comparison group (n=35; 41.7%). The main criterion for inclusion in the observation group was hypophosphatemia – serum phosphorus concentration ≤4.5 mg/dL (≤1.45 mmol/L). The comparison group included premature infants with serum phosphorus concentrations higher than the specified values. Laboratory monitoring of phosphorus-calcium metabolism indicators in dynamics was carried out at the age of 6–8 and 9–12 weeks of life. When the enteral nutrition was performed, the intake of calcium (mg/kg/day), phosphorus (mg/kg/day) and vitamin D (IU/kg/day) calculated on days 14, 28 and 42 of life. Statistical processing of the material was performed using non-parametric criteria. Differences were considered statistically significant at p<0.05.

Results. In the group of premature infants with hypophosphatemia, a long duration of parenteral nutrition was observed – 44.0 (36.5–52.5) days (p=0.010), low enteral supplementation of minerals and the need for prolonged respiratory support – 11.0 (6.8–26.3) days (p=0.049). Necrotizing enterocolitis was significantly more often diagnosed in the observation group (26.5% compared to 5.7%, p=0.015). The severe condition of the children in the observation group required a longer stay in the Perinatal Center – 67.0 (57.0–74.0) days [in the comparison group – 58.0 (45.3–69.5) days, p=0.023]. During X-ray examination at 6–8 weeks of life, signs of damage to the bone system characteristic of metabolic bone disease were observed only in children of the observation group – in 30.0% of those examined by X-ray methods.

Conclusion. The most significant clinical aspects identified in premature infants with hypophosphatemia are long-term parenteral nutrition and low enteral supplementation of minerals, due to decreased tolerance to enteral load, the nature and severity of the pathology, among which necrotizing enterocolitis and early neonatal sepsis play pivotal role. Radiological signs of metabolic bone damage at the age of 6–8 weeks were observed in 30.0% of premature infants with hypophosphatemia.

The article provides a review of the scientific literature devoted to the study of the health characteristics of newborns from mothers with breast cancer during pregnancy. Modern approaches to the treatment and prolongation of pregnancy in this cohort of women analyzed. The impact of maternal cancer and chemotherapy during pregnancy on the child’s health is discussed.

Kasabach–Merritt syndrome (KMS) is a rare disease characterized by the presence of a vascular tumor with progressive invasive growth, development of thrombocytopenia and consumptive coagulopathy. In the neonatal period, the disease can characterized by the skin manifestations and hide under the guise of an intrauterine infection. Depending on the location in different organs and systems, multiple organ failure develops. The article discusses modern approaches of the management of patients with KMS, and also given the description in a clinical case of the newborn with KMS. Manifestations of this syndrome were noted from birth. The presence of concomitant pathology can cause difficulties in making a right way of diseases.

Transient hyperammonemia of the neonate (THAN) is an abnormal condition characterized by increase of the ammonia blood levels (above 110 μmol/L in term infants and above 150 μmol/L in preterm infants) and do not associated with inborn errors of metabolism. THAN is usually caused by perinatal complications and occurs mostly in premature babies and babies with another disorders such as a perinatal asphyxia, a portosystemic shunting, the liver and renal failure and infections with urea-metabolizing organisms. Besides that, hyperammonemia can be caused of valproic acid as a seizures’ treatment in infants. Nevertheless, the etiology hyperammonemia can be a reason of the irreversible brain cells damage that defines the importance of an early detection and medical emergency.

The article is devoted to the debatable issue of mandatory implementation of clinical recommendations and their legal status. The article explains whether clinical recommendations form mandatory requirements, the implementation of which carried out within the framework of state quality control and safety of medical activities.

The article is devoted to the debatable issue of mandatory implementation of clinical recommendations and their legal status. The article explains whether clinical recommendations form mandatory requirements, the implementation of which carried out within the framework of state quality control and safety of medical activities.

The article presents draft of consensus guideline for clinical management of newborns with apnea of prematurity: definition, etiology, pathogenesis, classification, clinical features, diagnosis and evidence-based treatment, follow up, management algorithm and healthcare quality criteria.

The article presents guideline for the management of newborns with congenital cytomegalovirus infection approved by associations and Ministry of Health of the Russian Federation: definitions, etiology, pathogenesis, classification, clinical picture, diagnosis and treatment of this pathology based on evidence-based medicine, follow up, algorithm of doctor’s management and health care quality criteria.