Ultrasound screening of newborns from mothers with COVID-19 during pregnancy
SARS-CoV-2 infection during pregnancy can cause adverse maternal and fetal outcomes, but to this date its effects on infants born to mothers with COVID-19 are not well-studied, and more clinical observations are needed.
The aim of the study was to investigate spectrum of ultrasound changes in brain, heart and internal organs in children born to mothers who underwent COVID-19 during pregnancy.
Material and methods. Screening ultrasound examination of brain, heart and internal organs was performed on days 1-5 of life for 159 born to mothers who underwent COVID-19 during pregnancy born to mothers who underwent COVID-19 during pregnancy and 159 newborns comparable in gestational age and body weight, born in 2019 before the COVID-19 pandemic.
Results. In infants born to mothers who underwent COVID-19 during pregnancy, more often than in the control group, nonspecific ultrasound signs were detected that indirectly indicated on intrauterine infection [choroid plexus cysts and striatal vasculopathy (p<0.05)]. Frequency of ischemic and hemorrhagic brain lesions occurrence, as well as frequency of changes in structural imaging appearance of abdominal organs and kidneys did not differ between groups (p>0.05). In infants born to mothers who underwent COVID-19 during pregnancy, fetal communications functioned more often than in the control group, which could be associated with the examination at an earlier age in the main group (p<0.05).
Conclusion. Absolute majority of ultrasound changes detected in children born to mothers who underwent COVID-19 during pregnancy were characteristic of neonatal period and were not accompanied by clinical manifestations, with exception of rare findings in isolated patients. In children from the study group, indirect nonspecific signs of intrauterine infections were diagnosed statistically significantly more often than in the control group, while no differences in incidence of severe brain and internal organ lesions were found between the groups.
Features of hormonal status in late preterm infants in early neonatal period
The assessment of the hormonal status in the early neonatal period is a difficult task, since the level of hormones is subject to significant fluctuations depending on the gestational and postnatal age of the newborn, the type of delivery and anesthesia allowance in the mother, birth weight and many other factors. To date, data on the early hormonal response in premature newborns are few and often contradictory. The lack of unambiguous data on the early hormonal response in late preterm infants, on the one hand, and the rapid growth of this group of children, on the other, dictates the need for further research on the hormonal response to birth stress in late preterm infants.
Aim. To determine the features of the hormonal response in the early neonatal period in newborns with a gestation age of 34-36 weeks.
Material and methods. A prospective cohort study was conducted. The study included newborns with a gestation age of 34-36 weeks, born in the maternity Voronezh City Clinical Emergency Hospital No. 10 in the period from 06.2020 to 01.2021. A comprehensive assessment of the course of the period of early adaptation was carried out, the hormonal status of newborns was determined. The level of the following hormones was studied: TSH, T3, T4, cortisol. Blood sampling for the study was carried out immediately after birth from the umbilical cord vein and on the 4th day of life from the subcutaneous veins of the head in the morning hours before feeding.
Results. When analyzing the early hormonal response, we were unable to identify the influence of gender and gestational age on the levels of the studied hormones. When conducting a correlation analysis of the relationship between hormonal adaptation and anthropometric indicators, a statistically significant relationship (rxy=-0.293) between umbilical cord blood T3 and birth weight was revealed, while the relationship between other indicators of physical development and hormonal adaptation did not reach the levels of statistical significance. In the group of children born by caesarean section, the level of T4 of umbilical cord blood was higher compared to children born through the natural birth canal. In the group of children where the indications for delivery were from the fetus, there was a lower level of cortisol on the first day and T3 on the fourth day of life. We were not able to identify a statistically significant effect on the hormonal response in late preterm infants of pregnancy pathology, as well as the therapy carried out in pregnant women, including antenatal prevention with steroids. The relationship between the hormonal adaptation of late preterm infants and the volume of necessary intensive care was determined. Conclusion: The early hormonal response in late preterm infants is significantly influenced by the state of the mother-placenta-fetus system immediately before delivery, the type of delivery. There are close links between changes in the hormonal status and the volume of therapy. The question remains open as to how long the changes in hormonal status are lasting and how they affect the subsequent development of late prematurity.
Alterations in intestinal microbiota composition in cesarean section-born children and possibility of its correction
The article provides an overview of the scientific literature devoted to the study of the short and longterm consequences of the cesarean section for the health of the child. Disorders of the formation of intestinal microbiota in children born by cesarean section and their possible relationship with the risk of developing various diseases in children and adults are analyzed. The review discusses possible strategies aimed at minimizing the adverse effects of cesarean section, including special attention to breastfeeding and the use of synbiotics in the nutrition of infants in the first year of life.
Management of enteral nutrition of premature newborns who have undergone conservative necrotizing enterocolitis as the basis for favorable short and long-term outcomes
In the Last decade the search for the optimal enteral strategy for premature newborns who have suffered necrotizing enterocolitis (NEC) is the focus of the conservative care, and the enteral nutrition itself is recognized as a regulated factor. But at present, there are no convincing data and evidence-based recommendations on when and how to resume enteral nutrition after NEC. Given the lack of evidence and consensus among neonatologists and surgeons on the optimal feeding strategy after the diagnosis of NEC to prevent its recurrence, this challenge is one of the priorities and is still unresolved.
Neonatal lupus: diagnostic difficulties, treatment and prognosis in an extremely premature baby
Background. Neonatal lupus (NL) is a rare symptom complex of neonates that develops as a result of tissues' and organs' damage associated with transplacental passage of maternal anti-Ro and anti-La antibodies. The management of infants with heart injury as a result of NL represents great difficulties due to the rarity, heterogeneity of the manifestations of the disease and the lack of treatment protocols.
The aim was to describe a clinical course of NL with severe cardiac manifestations in extremely preterm newborn [gestational age (GA) 25 weeks]; with a relatively favorable outcome at the age of 18 months of life.
Case report. An extremely preterm girl weighing 980 g was born at 25 weeks GA by caesarean section due to persistent fetal bradycardia during routine obstetric ultrasound examination, which was regarded as a sign of fetal distress. The mother had no symptoms of rheumatic diseases. From birth - the baby had bradycardia without a tendency to recovery (heart rate 65-70 beats/min). According to electrocardiography data, grade III atrioventricular block was detected. The diagnosis of NL was confirmed by the presence of anti-Ro antibodies in the neonate and mother. Due to the presence of systolic myocardial dysfunction in the early neonatal period, an systemic steroid therapy was started, which was canceled after persistent hyperglycemia. On the day of life (DOL) 30, an increase of myocardial damage biomarkers was revealed (NT-proBNP, CPK) in the absence of echographic signs of cardiomyopathy, which was regarded as a possible antibody-associated myocardial damage, treatment with glucocorticosteroids was started, the course was interrupted at DOL 42 due to fungal infection. The levels myocardial damage biomarkers decreased to the norm at the age of 56 DOL.
The initial sepsis-checkup confirmed the realization of clinical early onset neonatal sepsis. During the treatment in the NICU, the neonate was diagnosed with disseminated candidiasis and acquired CMV infection with sepsis-like manifestation. Conducted 5 courses of antibacterial and 1 course of antimycotic therapy, taking into account the sensitivity of the detected microflora, antiviral therapy with a positive effect.
The clinical condition of the baby was complicated by the development of DIC syndrome (pulmonary hemorrhage and intraventricular hemorrhage of grade 2), the formation of a moderate form of bronchopulmonary dysplasia, and prolonged functioning of the hemodynamically significant ductus arteriosus.
The duration of respiratory therapy was 75 days (of which invasive mechanical ventilation was 45). The baby survived without major neonatal morbidities. Follow-up at the age of 18 months showed no disabilities nor psychomotor delay; no signs of cardiomyopathy; cardiac function was compensated without indications for cardiac pacing.
Conclusion. Multidisciplinary management, timely detection and reasonable treatment of complications made it possible not only to avoid lethal outcome in an extremely premature baby with comorbidity, including cardiac manifestations of NL, but also to ensure survival without disabling pathology. Probably "aggressive" steroid treatment led to discontinuation of antibody-dependent extranodal myocardial damage and prevention of irreversible postnatal complications of NL. However, this issue remains controversial due to the complications of steroid therapy and should be carefully weighed in terms of the risk/benefit ratio.
Bringing to disciplinary responsibility: what is important for an employee to know
The article discusses the procedure for bringing medical workers to disciplinary responsibility, the procedural features of the proceedings in the case of a disciplinary offense.
Sustainable neonatal CLABSI surveillance: consensus towards new criteria in the Netherlands
Background. Central line-associated bloodstream infections (CLABSI) are a main focus of infection prevention and control initiatives in neonatal care. Standardised surveillance of neonatal CLABSI enables intra- and interfacility comparisons which can contribute to quality improvement. To date, there is no national registration system for CLABSI in neonatal care in the Netherlands and several criteria are used for local monitoring of CLABSI incidence rates. To achieve standardised CLABSI surveillance we conducted a consensus procedure with regard to nationwide neonatal CLABSI surveillance criteria (SC).
Methods. A modified Delphi consensus procedure for the development of nationwide neonatal CLABSI SC was performed between January 2016 and January 2017 in the Netherlands. An expert panel was formed by members of the Working Group on Neonatal Infectious Diseases of the Section of Neonatology of the Dutch Paediatric Society. The consensus procedure consisted of three expert panel rounds.
Results. The expert panel achieved consensus on Dutch neonatal CLABSI SC. Neonatal CLABSI is defined as a bloodstream infection occurring more than 72 h after birth, associated with an indwelling central venous or arterial line and laboratory confirmed by one or more blood cultures. In addition, the blood culture finding should not be related to an infection at another site and one of the following criteria can be applied: 1) a bacterial or fungal pathogen is identified from one or more blood cultures; 2) the patient has clinical symptoms of sepsis and 2A) a common commensal is identified in two separate blood cultures or 2B) a common commensal is identified by one blood culture and C-reactive protein level is above 10 mg/L in the first 36 h following blood culture collection.
Conclusion. The newly developed Dutch neonatal CLABSI SC are concise, specified to the neonatal population and comply with a single blood culture policy in actual neonatal clinical practice. International agreement upon neonatal CLABSI SC is needed to identify best practices for infection prevention and control.